Community Engagement To Improve Health Fieldwork Report - NICE UK - 2008

A BMRB report for:
NICE
Findings from fieldwork on Draft Community
Engagement Guidance
Report
September 2007
Prepared for: National Institute for Health and Clinical Excellence

(NICE)
Prepared by: Claire McAlpine, Sue Clegg and Darren Bhattachary
BMRB
Telephone: 020 8433 4394
Email: claire.mcalpine@bmrb.co.uk
Part of BMRB Limited (British Market Research Bureau)
BMRB /45106553
BMRB is ISO9001:2000 and ISO 20252 accredited.
Copyright: findings and deliverables are normally intended for use within the Client's organisation or its
consultants and other associate organisations such as advertising agencies. Should the Client intend wider
circulation of the survey findings and deliverables, the Client should inform BMRB prior to such disclosure
and agree the form and content with BMRB. The client should acknowledge BMRB as the source of the
information with wording acceptable to BMRB.
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Table of Contents
Executive Summary ............................................................................................... 4
1 Introduction....................................................................................................... 8
2 Research design ............................................................................................. 10
3 Views on the Guidance as a whole.......................................................... 18
4 Recommendations ......................................................................................... 26
5 Style and format of the guidance ............................................................ 40
6 Barriers to implementing the guidance ................................................ 46
7 Improving health and tackling health inequalities .......................... 52
8 Conclusions ...................................................................................................... 54
Appendices .............................................................................................................. 58
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Acknowledgements
We would like to thank Lorraine Taylor, Amanda Killoran, Antony Morgan and the rest of
the research team at NICE for their help and support with this project.
We are also grateful to the BMRB Field Management Team who co-ordinated the
dedicated recruiters who worked on this project for their hard work and effort
throughout. Our thanks go to the remaining members of the research team: Eleanor
McDonald, Robert Fish and Glenys Davies.
Finally, we would like to express our gratitude to those who participated in the research
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Executive Summary
The Centre for Public Health Excellence at the National Institute for Clinical Excellence
developed a draft guidance on Community Engagement. BMRB Social Research were
commissioned to evaluate the draft guidance with those involved with comities and
vulnerable groups.
Research Design
The research involved qualitative interviews and group discussions and a small scale
survey. The qualitative work took place in the North East and South West, and the
survey across several geographical locations in England. The following took place:
40 interviews (a combination of face to face and telephone interviews)
4 group discussions (2 each in the North East and South West)
50 responses to the survey were received.
General views on the guidance
Overall the guidance was viewed positively. It was seen as highlighting NICE’s support
for community engagement methods, and as reinforcing the need for strategic and
community organisations to engage with local communities. The guidance was felt to fit
well with other agendas such as ‘Every Child Matters’ and ‘Health Scrutiny Agendas’.
The principles outlined in the guidance were familiar to respondents and were usually
working towards community engagement in their own organisations; however, this was a
key criticism of the guidance, with respondents feeling that it was not covering ‘new
ground’. It was acknowledged that for organisations less familiar with the concept of
community engagement the guidance would be a useful tool.
The guidance was seen as being useful as a ‘blue print’ for organisations to check that
they were undertaking community engagement correctly, particularly those new to the
concept of community engagement.
Whilst the guidance was generally felt to be relevant to participants it was pointed out
that there was a gap in terms of children’s and young people’s organisations.
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It was felt that the guidance would benefit from being more directive, and from including
practical information for how to take forward community engagement.
The Recommendations
The recommendations section of the guidance was seen to be the most important part of
the document. Eight of the recommendations were thought to be of particular
importance:
Long term planning (recommendation 1)
Levels of engagement and power (recommendation 2)
Trust and respect (recommendation 3)
Avoiding pitfalls (recommendation 4)
Infrastructure (recommendation 5)
Partnership working (recommendation 8)
Training (recommendation 9)
Evaluation (recommendation 18)
Several suggestions were made for improving the recommendations overall, by:
Highlighting the importance of education in health improvement throughout the

recommendations
Emphasising the importance of honest feedback to the community regarding

decisions which had been made and the effectiveness of local initiatives
Providing advice on how to engage with vulnerable client groups
Including all communities of interest
Recognising the importance of volunteer workers
Reducing repetitiveness of the recommendations
Having consistency regarding ‘who should take action’
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Ensuring the recommendations do not imply community engagement should be
done to communities
Providing titles for all recommendations
A common request was that the recommendations should contain guidelines for how to
implement them.
Style and format of the guidance
Concerns were expressed about the style and format of the recommendations, with
respondents saying that they could negatively impact on how readers responded to the
guidance, and ultimately how effective it would be in improving health and reducing
health inequalities.
The language of the guidance was of particular concern, with participants expressing the
view that the document was not easy to read, and so could be off-putting for some
people, particularly those unused to using such documents, for whom the guidance was
thought to be of particular relevance.
The length of the guidance was also thought to be a barrier to use for some people, with
the intended audience not having time to read it.
Barriers to implementing the guidance
Lack of resources was perceived to be the major barrier to implementing the guidance.
Such lack of resources included both staff time and money to undertake work needed.
Other barriers were:
Lack of ‘how to’ information
The length of the guidance and the language used
Promotion of the guidance – this was highlighted as a potential barrier if the

guidance is not well promoted, however it was also seen as a key enabling factor
if done well
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Unwillingness to implement the guidance and recommendations on the part of
some local authorities
Lack of support from key bodies and organisations
Consultation apathy
Improving health and tackling health inequalities
There were mixed views about whether the guidance had the potential to improve health
and tackle health inequalities; in the main the recommendations were seen to have the
potential to do so, assuming the key barriers to implementation were tackled.
Conclusions
The guidance was seen as supporting and giving credibility to the concept of community
engagement, although some improvements to the recommendations were felt to be
needed if they were to be of use, and the barriers identified needed to be addressed.
A key consideration in reviewing the guidance was that respondents felt the need for
concrete suggestions for how each recommendation could be implemented.
Challenges faced during the research have been identified, and recommendations made
for overcoming them in the future.
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1 Introduction
1.1 Background to the research
The Centre for Public Heath Excellence (CPHE) at the National Institute for Clinical
Excellence (NICE) developed draft guidance on community development and engagement
methods and approaches for improving health and reducing health inequalities. The draft
guidance draws on a range of evidence of methods and approaches for involving
communities at the consultative and informing levels, as well as in the co-production of
activities and services, including devolving power and control, to ensure the greatest
impact on health outcomes. The draft guidance considers the effectiveness and cost
effectiveness of a range of engagement methods and approaches, together with cultural
and institutional factors affecting their adoption. The final guidance is due to be issued by
NICE in early 2008 to the NHS, Local Authorities and other community organisations.
1.2 Research aim and objectives
Aim
The aim of this project was to evaluate the draft community engagement guidance with
those involved in working with communities and vulnerable groups.
Objectives
Specifically the project’s objectives were to:

• Evaluate the relevance and usefulness of the guidance to those working locally
with communities and vulnerable groups with regard to:
o Their current practice
o The potential to improve health and tackle health inequalities
• Explore the views of ‘communities’ on the usefulness, relevance and potential
impact of the guidance for improving health and tackling health inequalities
• Explore factors which might help or hinder implementation and delivery of the
guidance, with specific reference to the roles and capacities of the statutory,
community and voluntary sectors.
1.3 Report outline
Following this introductory section, the report is divided into 7 further chapters. Chapter
2 discusses the design of the research; Chapter 3 considers views on the guidance as a
whole; Chapter 4 is concerned with the recommendations section of the guidance;
Chapter 5 considers the style of the guidance; Chapter 6 discusses barriers to
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implementing the guidance; Chapter 7 discusses the guidance’s potential to tackle health
inequalities; and conclusions are presented in Chapter 8.
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2 Research design
This chapter discusses the research design used for the study, including the methods
used for analysis of the data.
The challenge for this project was to develop an approach that could provide detailed
feedback on the guidance and test its feasibility for implementation, whilst being mindful
of views across the whole health gradient and spectrum of the population. To address
this, a two stage methodology consisting of qualitative fieldwork (depth interviews and
group discussions) and a small scale survey was used.
2.1.1 Qualitative fieldwork
The methods employed in the first stage of this research were qualitative in nature. This
approach was adopted to allow for individuals’ views and experiences to be explored in
detail. Qualitative methods neither seek, nor allow, data to be given on the numbers of
people holding a particular view nor having a particular set of experiences. The aim of
qualitative research is to define and describe the range of emergent issues and explore
linkages, rather than to measure their extent.
Geographical areas
Two English regions were chosen for this research: the North East and the South West.
These areas have marked inter and intra regional differences in health inequalities and
deprivation levels 1 (please see below footnote for more information).
Numbers of interviews and groups
Forty depth interviews were conducted with representatives of community and strategic
organisations across the South West and North East of England (Please see Appendix A
for details of respondents). Interviews were either conducted face-to-face or on the
telephone, depending on the respondents’ preferences and the need to cluster face-to-
face interviews together to make them economically viable.
Four group discussions (of seven to eight respondents in each group) were also
conducted with members of community groups and strategic organisations (please see
1
For instance, for the period 1999-2003, 40 per cent of wards in the North East were in the 20 per cent of
wards in England and Wales with the lowest levels of life expectancy at birth, compared with only 7 per cent in
the South West [ONS (2006) New experimental life expectancy figures for small areas. Available at:
http://www.statistics.gov.uk/pdfdir/lex0606.pdf]. Similarly, for the period 1998-2004, the North East also had
the lowest average household incomes per head in England [DTI (2006) Regional competitiveness and state of
the Regions. Available at: http://www.dtistats.net/sd/rcsor2006html/section1.htm].
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appendix A for a details of respondents). Two of the groups were recruited and
conducted in the South West (Plymouth and Taunton) and two in the North East
(Sunderland and Northumberland).
Recruitment of participants
To recruit for the qualitative fieldwork, BMRB developed a sample of key individuals
across the South West and North East of England; this was done by internet searching
for organisations likely to be involved with, or working in the field of, community
engagement, and for individuals whose job roles were likely to give them insight into the
issues around community engagement.
A full briefing with field managers on the project and detailed recruitment instructions
ensured recruitment was carefully managed. A screening questionnaire was also
provided to enable the recruiter to screen for respondents’ eligibility to participate in the
research. All recruiters are members of the IQCS (Interviewers Quality Control Scheme).
One recruiter was used to recruit the respondents by telephone.
Each potential respondent was sent an invitation letter outlining details of the research
(please see Appendix B), which was followed up with a telephone call from one of BMRB’s
specialist recruiters, to ask them to participate and to set up an interview date. All
respondents were emailed the draft guidance and an introductory letter (see appendix C)
following publication of the guidance on the 23rd August 2007.
Conduct of the interviews and group discussions
The in-depth interviews and group discussions were carried out by five experienced
qualitative researchers who have extensive experience of conducting qualitative fieldwork
and have been trained the use of non-directive techniques.
All members of the research team took part in a briefing to ensure the methodological
approach was consistent across the interviews and discussions.
Each interview and group discussion was exploratory in form so that questioning could be
responsive to the experiences and circumstances of the individuals involved. They were
based on a topic guide (see Appendix D) 2 , which listed the key themes and sub topics to
2
It should be noted that the topic guide was amended after the groups and a few of the interviews had taken
place, as the researchers were finding it difficult to address all of the issues in the original topic guide. This
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be addressed and the specific issues for coverage within each. Although topic guides
help to ensure systematic coverage of key points across interviews and discussions, they
are used flexibly to allow issues of relevance for individual respondents to be covered
through detailed follow up questioning.
All interviews and group discussions were recorded and transcribed.
The analysis of qualitative material using Matrix Mapping
Material collected through qualitative methods is invariably unstructured and unwieldy.

Much of it is text based, consisting of verbatim transcriptions of interviews and
discussions. Moreover, the internal content of the material is usually detailed and in
micro-form (for example, accounts of experiences and inarticulate explanations). The
primary aim of any analytical method is to provide a means of exploring coherence and
structure within a cumbersome data set whilst retaining a hold on the original accounts
and observations from which it is derived.
Qualitative analysis is essentially about detection and exploration of the data, making
sense of the data by looking for coherence and structure within the data. Matrix Mapping
works from verbatim transcripts and involves a systematic process of sifting,
summarising and sorting the material according to key issues and themes. The process
begins with a familiarisation stage and includes a researcher’s review of the audio files
and/or transcripts. Based on the coverage of the topic guide, the researchers’
experiences of conducting the fieldwork and their preliminary review of the data, a
thematic framework is constructed. The analysis then proceeds by summarising and
synthesising the data according to this thematic framework using a range of techniques
such as cognitive mapping and data matrices. When all the data have been sifted
according to the core themes the analyst begins to map the data and identify features
within the data: defining concepts, mapping the range and nature of phenomenon,
creating typologies, finding associations, and providing explanations.
The analyst reviews the summarised data; compares and contrasts the perceptions,
accounts, or experiences; searches for patterns or connections within the data and seeks
explanations internally within the data set. Piecing together the overall picture is not
simply aggregating patterns, it also involves a process of weighing up the salience and
dynamics of issues, and searching for structures within the data that have explanatory
power, rather than simply seeking a multiplicity of evidence.
amendment was undertaken at the suggestion of NICE staff that had observed three of the four groups
discussions, and was done in agreement with the NICE team. Such amendments are usual in qualitative
research, as the topic guides are not used as questionnaires, but as aides memoire.
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The use of qualitative data in this report
This report is mainly based on the themes and issues arising from the analysis of the
qualitative data from the interviews and group discussions. Verbatim quotations are
used throughout the report to illustrate points being made.
2.1.2 Small scale survey
An electronic survey explored the views of individuals across various geographic areas,
service providers and communities of interest.
This survey consisted of six attitudinal statements (please see Appendix E or below) on
which respondents rated their agreement/disagreement, and six open ended questions to
explore negative responses.
Survey sample
BMRB developed a sample of 517 individuals whose work included engaging with local
communities on health promotion initiatives or initiatives that addressed the social
determinants of health. Again, this sample was achieved by internet searching, and, in
some cases, by recommendations from NICE’s PDG and staff .
Conduct of the survey

Each potential respondent was emailed the same invitation letter as the depth/focus
group respondents (Appendix B) which was followed up by an email including the draft
guidance, an information sheet (Appendix F) and the short questionnaire on the 23rd
August 2007. Respondents were sent a reminder email two days before the deadline
(3rd September 2007), and those who had not completed the questionnaire after this
deadline were sent an email extending the deadline until the 7th September 2007.
The survey questions

The six altitudinal questions in the survey were all designed to be answered with one only
of the following responses:
Agree strongly
Agree
Disagree
Disagree strongly
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The omission of a ‘middle ground’ option for answering was purposeful, to eliminate the
possibility of respondents merely ticking the middle-most answer (which could have
been, for example, ‘neither agree not disagree’).
The survey questions were as follows:

Q.1 The language used within the guidance and the recommendations is easy to
understand
Q.2 The guidance and the recommendations are very relevant to my current
practice and the organisation/s which I work with
Q.3 The organisation/s which I work with have adequate resources to implement
the guidance and recommendations
Q.4 I am satisfied that the guidance and the recommendations are relevant to the
needs of all communities
Q.5 The guidance and the recommendations are useful for organisations working
with communities to improve health and tackle health inequalities
Q.6 I do not imagine that there will be any barriers to implementing this guidance
and the recommendations within the organisation/s I work with
Each question was followed by an open ended question, for clarification of negative
responses:
If you ticked ‘disagree’ or ‘disagree strongly’ please use the space below to
explain your answer
Data was also collected on respondents, to classify answers according to type of

organisation.
Please see Appendix E for a copy of the survey questionnaire.
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Responses to the survey
From the sample of 517 individuals 50 responses to the survey were received. Although
this is a small number of responses the spread of organisation type and location was
relatively good. Forty nine of the fifty respondents gave information about the type of
service they represented, as follows:
Service type (or role) Number

Councillor 2
Disadvantaged & vulnerable group service 6
Neighbourhood based management and/or community empowerment programme 15
Other* 18
PCT or LA with community involvement function 8
Total 49
Table 1: Service type of survey respondents
*In the table above ‘Other’ represents groups which did not fit into the existing
categories. Eleven the ‘Other’ grouping represented ‘general’ communities of interest, 3
‘older people’, 3 ‘BME groups’ and 1 a ‘general’ group.
The regions represented by the survey participants were:
Region Number
East Midlands 4
East of England 4
London 10
North East 7
North West 7
South East 4
South West 4
West Midlands 4
Yorkshire & Humber 6
Total 50
Table 2: Regions represented in survey
Thirty six of the respondents represented organisations working mainly in urban areas
and nine represented organisations working mainly in rural areas (five respondents did
not answer this question).
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The communities of interest represented by survey respondents were:
Community of interest Number

BME groups 5
Disability groups 2
General 30
Older people 6
Other 5
Women 2
Total 50
Table 3: Communities of interest represented in the survey
Analysis of the survey data

The data from the survey was entered into an Excel spreadsheet, developed for this
research, and was then analysed by producing pivot tables to give cross tabulations of
answers to questions by organisation type. The data from the open ended questions was
analysed by putting comments into a matrix, and looking for commonalities and
differences between answer types.
The use of quantitative data in this report

Graphs showing responses to the survey questions appear throughout this report. Data
from the open ended questions in the survey are included alongside the qualitative data,
and are identified as being survey answers.
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3 Views on the Guidance as a whole
This section considers respondents’ views of the draft community engagement guidance
as a whole document. Where respondents have raised points around the usefulness and
relevance of specific recommendations, these are discussed in section 4.
3.1 Usefulness of the draft community engagement guidance
The guidance was seen as a document which highlighted NICE’s support for community
engagement methods, which in turn would serve to reinforce the need for strategic and
community organisations to engage with local communities. By creating a community
engagement guidance, NICE was seen as giving credibility and importance to the idea of
‘community engagement’.
Overall, respondents agreed with the issues and recommendations made, and felt very
familiar with the principles portrayed within the document. However, this was one of the
key criticisms of the draft community engagement guidance in that the guidance was not
perceived as covering ‘new ground’. There were respondents who felt their organisations
were currently working towards the recommendations with their own plans and policies
and questioned the need and usefulness of the guidance.
“It doesn't contradict anything else I’ve seen but why reinvent the wheel
and do another document. Why not use resources already available?”
Group Discussion 4, South West; Somerset
On the other hand, there were respondents at both strategic level and from community
groups who felt that whilst they were familiar with all that the guidance recommended, it
provided them with an opportunity to ‘check they were doing it right’. The guidance was
also considered useful to those new to the concept of community engagement (concerns
were raised around the style of the language for those new to community engagement –
this is discussed further within section 5.2).
“I think they will be useful for some people, you know, perhaps newer
people in this area of work or you know as a start point for this sort of
approach…but there wasn’t much that was new to me.”
Manager, SureStart
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The glossary was found to be helpful, and thought to be particularly useful for those new
to the concept of community engagement. However, specific concerns were raised
around the definitions of ‘Community Engagement’ and ‘Community Development’ in the
glossary. The first concern was that the guidance did not adequately explain what these
terms mean, so people new to the concept would not be able to understand them. The
second critique was that the guidance did not adequately address debates around the
distinction between these two terms, which could result in the terms being used
interchangeably.
“Although there is a brief reference to the distinctiveness of community

engagement and community development they are in the vast majority of
references in the report linked in an umbilical way to the extent that many
will see them as interchangeable”
Women’s Organisation - Survey response 3
The potential for lack of distinction between ‘Community Engagement’ and ‘Community
Development’ led to respondents suggesting that the guidance would benefit from
explicitly stating NICE’s standpoint on these two terms and stating that it is recognised
that debate currently exists around the definitions.
“When you talk with some groups they’ll see a very distinct delineation
between community engagements and community development, and there
are a lot of very detailed conversations and discussions and arguments
that people will have about the difference between the two…(the guidance
needs to be) something that really just expressly lays out the way that this
document views it, in that it is encompassing, it recognises that it
encompasses a very wide range of differing perspectives, differing
definitions, and that I think will help it to be better viewed by some
organisations”
Head of Public Health, Healthy Community Organisation
Respondents felt that the guidance would be useful to use as a blueprint for best
practice, but suggested that it provided very little practical advice. A key critique of the
guidance was that it stated ‘what’ should be done, without explaining ‘how’ it could be
3
Whilst the survey asked specific questions, there were respondents who chose to include additional comments
in a separate document. These have been highlighted and included throughout the report where appropriate.
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done. It was felt that the guidance assumed that readers would know how to implement
the recommendations; for example one respondent stated that the idea of community
engagement is laudable but that in practice it is very difficult.
“I’ve got a scribbled note here ‘involve resident members of the community
from the outset’ well I’ve got a question mark, ‘how?’…its alright stating
these things in what you want done but sometimes it’s very difficult…I
keep coming back with a question mark. Fine, we’ve heard it all before,
but how are we going to do it?”
Chair, Patient and Public Involvement Forum
Further concerns were raised as to how useful the guidance would be used in current
practice. It was suggested that ‘community engagement’ as a concept is nebulous and
this itself would cause problems implementing the guidance, for example identifying
target populations.
“The bit, it keeps repeating who’s the target population and who should
take action…and it’s like well what does that actually mean because, yes
it’s just, I think that bit’s very nebulous.”
Drug Action Team Coordinator
It was suggested that the guidance would greatly benefit from being more directive and
including practical advice such as;
o A ‘how to’ section listing best practice techniques
o Advice on where to go for ‘tools’
o Templates and tools 4
o Specific information on who should have training and where from
o A directory of key people and organisations to contact
4
It should be noted that the draft version of the community engagement guidance did not contain a ‘tool kit’.
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Whilst the lack of ‘how to’ and specific details in the guidance was, overall, perceived to
be a weakness, there were respondents working in more strategically based
organisations who perceived this to be a strength. Not including specific details within
the guidance and recommendations helped the guidance to be open to interpretation and
therefore applicable to a wider audience.
A further point which was considered to be useful about the guidance was that it was
perceived to fit in well with other agendas such as ‘Every Child Matters’ and Health
Scrutiny Agendas.
3.2 Relevance of the draft community engagement guidance
On the whole, the guidance was considered by respondents to cover a subject area that
was very relevant to the organisations they worked with. This is also reflected in the
results from the small scale survey for question 2 (‘The guidance and the
recommendations are very relevant to my current practice and the organisation/s which I
work with’). As shown in graph 1, all but one of the respondents either agreed or agreed
strongly that the guidance and recommendations were very relevant to their current
practice.
Q2 - Relevant to current practice
10
9 Councillor
8
Disadvantaged & vulnerable group
7 service
6
count
Neighbourhood based management

5 and/or community empowerment
programme
4 PCT or LA with community involvement
function
3
2 Other
1
0
agree agree disagree
strongly strongly
Graph 1 – Responses to Survey Question 2 ‘The guidance and the recommendations are
very relevant to my current practice and the organisation/s which I work with’.
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(Note: In this graph, ‘Other’ represents the following communities of interest: Agree – 2 BME
groups, 6 general groups and 1 group representing older people; Agree Strongly – 4 general
groups, 2 older people’s groups and 1 ‘other’ group; Disagree Strongly – 1 BME group)
In probing respondents in more detail during the depths and group discussions the
responses that were given suggested that although the topics of health inequality and
community engagement itself was considered relevant, respondents called into question
the relevance of specifics of the guidance, such as the language used and individual
recommendations. The format and language of the guidance was felt to be more
relevant to those in strategic organisations compared with those who work directly with
communities. Additionally, the relevance of the guidance came into question when
respondents considered the usefulness of the guidance, particularly because there were
respondents who were already working towards the implementation of similar
recommendations through other guidance/policies. Those respondents who had similar
guidance or policy in their organisation felt they would not use the guidance as they
would prefer to use their own guidance, which was often locally orientated.
“It is relevant to me...but we’ve got Community Engagement Guidelines

ourselves within the Council…yes, the Government guidelines on
consultation (and) community engagement, so if I was looking for
guidance on something that’s probably where I’d go, I don’t think I would
go to this (NICE draft community engagement guidance)”
Community Engagement Officer, Local Authority
On an individual level, respondents who felt familiar with the concept of community
engagement, despite feeling that the guidance was relevant, doubted if they would use
it. This was in part due to respondents feeling that a large amount of other information
regarding community engagement was also available.
“So would I have read it if it had come on my desk? I don’t know. There’s
sometimes a lot about on community engagement, isn't there”
Manager, Youth Offending Team
It was felt that the guidance would be particularly relevant, as well as useful, to those
less familiar with, or new to, community engagement.
In judging the relevance of the guidance to themselves and the organisations they
worked with, community organisations in particular would look to see who the target
population was for each recommendation and who should take action. As a result, there
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were respondents from community groups and in strategic roles who felt only parts of
the guidance were relevant to them, namely the recommendations which mentioned
either their client group as a target population or them as a group who should take
action. In particular, children’s and young people’s organisations highlighted that
children and education were rarely mentioned in the guidance and recommendations,
and therefore suggested that the guidance may not be relevant to their organisations.
“The target population doesn’t seem to outline vulnerable young people,

and you always look for your own areas. It talks about the target
population a number of times but I don’t think it actually mentions young
people. When I didn’t see young people, I thought this was very much
aimed at adult health issues”
Manager, Youth Offending Team
Survey respondents were also asked whether they considered the guidance to be
relevant to the needs of all communities. As can be seen from the graph below, there
were mixed responses to this question, with almost a quarter of respondents
disagreeing:
Q4 - Relevant to needs of all communities
10
Councillor
9
8
7 Disadvantaged & vulnerable group
service
6
count
5 Neighbourhood based management

4 and/or community empowerment
programme
3
PCT or LA with community
2 involvement function
1
0 Other
agree agree strongly disagree
Graph 2 – Responses to Survey Question 4 ‘I am satisfied that the guidance and the
recommendations are relevant to the needs of all communities’
groups, 5 general groups and 1 group representing older people; Agree Strongly – 1 group
representing older people, 1 general group and 1 ‘other’ group; Disagree – 1 BME group, 4 general
groups and 1 group representing older people)
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The reasons given for negative responses included views that there were gaps in the
guidance for specific groups, for example one respondent wrote:
“Although BME, elderly and disabled groups are mentioned, there are other
vulnerable groups which need including such as, children, travellers,
refugees and asylum seekers and carers. More emphasis is needed on the
differing needs of vulnerable groups and vulnerable communities regarding
engagement and participation.”
Respondent representing an in the North of England (Urban), with a wide

remit including refugees and asylum seekers, travellers, and carers.
However, most respondents who elucidated their answers raised concerns about the
resources needed to implement the guidance, and felt that there would be some groups
who would not be able to work with them due to lack of resources, thus making the
guidance of limited relevance to them. One respondent wrote:
“Pardon me for sounding cynical, but… this report and recommendations

will do very well - thank you - in middle class suburbia, but, will fail in the
poorer parts of town if not adequately funded and resourced for longer
term input than 2-3 years. I feel funders/decision makers underestimate
the time it takes to build confidence and capacity in deprived communities”
Respondent representing an group in the Midlands (Urban), in an

outer-city deprived housing estate.
The lack of resources related not only to money, but also to people within groups who
could understand, and work with the guidance:
“Whilst the ethos of the recommendations certainly seems to be inclusive,

the length, structure and language may make it inaccessible for some
communities.”
Respondent representing a neighbourhood based management

and/or community empowerment programme in London (Urban).
24
3.3 Views on the ‘Public Health Need and Practice’ and
‘Considerations’ sections 5
The main focus of the interviews and the group discussions was the Recommendations
section of the guidance, however there were some views expressed about the Public
Health Need and Practice and Considerations sections of the document.
There were three types of views expressed about the type of information contained in
these sections, with respondents from across organisation types expressing all three
viewpoints:
That the information was useful, and more signposting backwards and forwards
from the Recommendations section would have been welcomed
For these respondents, the information contained in these sections was of great
interest and they would have welcomed, for example, footnote explanations of
other documents referenced throughout guidance or hyperlinks between the
recommendations and the Considerations or background evidence relating to
them.
That the sections seemed very academic, and therefore off-putting
Respondents expressing this view tended to think that the academic language and
the evidence presented made the guidance a difficult document to use.
“There is a lot of ‘gumf’ to get through before getting to the main meat of
the document. In particular some of the ‘considerations’ could perhaps be
condensed and some of the ‘evaluation’ and ‘limitations’ section put in
appendix”
Programme Manager, New Deal for Communities
That more rigour was needed
There were some respondents who felt that the guidance, and particularly the
Considerations section, should be more cautious in the language it used. They
felt that NICE should be applying same level of academic rigour to the production
of this guidance as they would when considering whether, for example, a certain
drug should or should not be used, for example 'is there any evidence that you're
going to make any progress?'. For these respondents the Considerations section
did not seem to give enough evidence of academic rigour.
5It should be noted that the emphasis of the interviews was on the Recommendations section of the guidance,
and not all respondents discussed the two sections discussed here.
25
4 Recommendations
This section discusses views of the recommendations as a whole and identifies the
recommendations which were felt to be most important. The section concludes with a
detailed look at each recommendation and the key changes which were suggested to
improve each recommendation.
4.1 Views on recommendations as a whole
The recommendations were considered to cover the key areas and issues involved in
community engagement and health, and was felt to be the most important and useful
section of the draft community engagement guidance. Indeed, there were suggestions
that the recommendations could be a stand alone document in itself (this is discussed
further within section 5.3).
4.1.1 Most important recommendations
Individual recommendations were identified by respondents as being particularly

important, with the majority (recommendations 1, 2, 3, 4, 5) of these being
recommendations identified as ‘essential conditions required if community
engagement/development activities are to be undertaken’ in the guidance (in the order in
which they appear in the guidance):
o Long term Planning (Recommendation 1)
o Levels of engagement and power (Recommendation 2)
o Trust and Respect (Recommendation 3)
o Avoiding pitfalls (Recommendation 4)
o Infrastructure (Recommendation 5)
o Partnership Working (Recommendation 8)
o Training (Recommendation 9)
o Evaluation (Recommendation 18)
The above recommendations were also usually those which respondents identified as the
most useful and relevant. These recommendations (and those not listed above) are
discussed in more detail in section 4.2. These recommendations were considered to be
26
the most important to implement and to have a large role in effective community
engagement. For example, there were respondents from both strategic and community
organisations who felt that recommendations 1-5, and for one respondent
recommendations 1-3, covered a good proportion of the issues involved.
“I think the first three…just because I think they are pretty overwhelming
and if they get that right they will be halfway there”
A key finding to emerge was that by numbering the recommendations 1-18 there was a
suggestion of hierarchy of importance. There were respondents from all types and levels
of organisation who suggested that ‘important’ recommendations should be placed at the
beginning of the recommendation sections; Infrastructure, Evaluation and Partnership
working were specifically identified. If NICE had not intended any recommendation to be
perceived as more important than another, it was felt important that this was explicitly
stated within the guidance. One respondent felt this could be represented visually within
a circle showing each recommendation to have equal weight.
“If they are intended to be of equal or have an equal value, then

presenting them as a narrative list automatically starts a hierarchy because
the first one you read is going to be the most important one that you might
think about, so if they were presented as, I don’t know, some sort of
model, circle, like pie diagram of equal size, you know the wedges are
equal size on the pie diagram, so that the reader is under no illusion that
these are all the ingredients that you would need to have for a robust
community development intervention.”
Public Health Consultant, Primary Care Trust
There were also respondents, both at strategic and community level, who felt that this
section of the guidance should indicate and highlight how each recommendation was
related to others (for example, trust and long term planning – see section 4.2).
4.1.2 Suggestions for improvement to recommendations as a whole
Suggestions for improvement were made which relate generally to all recommendations.
These are discussed here, with suggestions for improvement relating to specific
recommendations discussed in section 4.2.
27
Nine key improvements were suggested;
1. Highlight the importance of education in health improvement throughout the

recommendations
2. Emphasise the importance of honest feedback to the community on decisions

that have been made, why decisions have been made and the effectiveness of
local initiatives
3. Provide advice on how to engage with vulnerable client groups, for example,
drug users
4. Ensure readers are not excluded by mentioning all communities of interest,

particularly children and young people. If this list of communities is not
comprehensive, balance this by ensuring that the target populations are not
too specific so that recommendations will be considered relevant to a wide
range of organisations
5. Recognise the importance of volunteer workers throughout the

recommendations
6. Reduce repetitiveness of the recommendations – particularly ‘who is target

population’, ‘who should take action’ and ‘what action should they take’
7. Have consistency across the recommendations regarding ‘who should take

action’ for example, Sure Start are specifically mentioned in some
recommendations but not others
“I am sort of a little bit confused - reading through Sure Start appeared

(in some section but) it wasn’t appearing in some other sections and I
wasn’t clear what the rational was for that…I wasn’t totally sure why
Sure Start had been put in at one section but not others.”
Manager, SureStart
8. Ensure that recommendations (and guidance) do not imply community

engagement should be done to communities for example;
o ‘Target population’ – it was suggested that this term gave the

impressions that engagement was being done to communities rather
than with them
28
“I said earlier on about it being about feeling as if people were
being done unto a little bit, the use of a ‘target population’ term
sort of seems to add to that kind of thing that I didn’t like around
the overall approach to the wording, so you know, who can get
involved? Who can benefit? The ‘target population’ makes it sound
as if we are directing something at people, not working to improve
and engage.”
9. Provide titles for all recommendations (for example, recommendations 10-12

and 14-17)
4.2 Views on specific recommendations
o Long term Planning (Recommendation 1)
This recommendation was considered particularly key by respondents, and in

terms of the structure of the guidance – a sensible ‘place’ at which to start the
recommendations. Respondents highlighted that long term planning was
important to ensure project sustainability, which in turn can help to develop the
other guidance recommendations such as trust and respect (recommendation 3).
In discussing planning, the value of long term funding was raised to help ensure
organisations are given the means to ‘make a real difference’ in the local
community.
“We operate on very short term contracts or short term funding, which can
be a year, 2 years to 3 years funding. That’s not very good when you’re
trying to keep a project sustainable or you know you’re trying to have a
long term future where the project can actually make a real difference to
local people… you’ve got to have that sustainability otherwise you’re just
raising peoples (expectations)”
Assistant Director – Community Partnership Organisation
29
Suggestions for improvement:
o State HOW to implement long term planning – as with much of the

guidance, this recommendation was criticised for not stating how to
implement long term planning
o Highlight importance of time required to set up projects
o Include that it is important to have mechanisms that monitor and allow

organisation to intervene in projects which are not currently delivering, to
enable further help to be provided.
o Important that long term planning engages with local priorities, such as
Local Area Agreements (LAA). This can also help to ensure projects are
not duplicated and funding is used effectively.
o Levels of engagement and power (Recommendation 2)
Involving relevant members of the community was considered key and stressed
that it should be done from the outset of a project. As suggested in the guidance,
the need for feedback mechanisms was also highlighted as being of particular
importance in engaging groups. Respondents agreed with the recommendation to
engage with people from a wide variety of backgrounds and felt that shared
power was an important issue to address.
“Recommendation two is important as well, because within our project

there's no hierarchy within the groups, you might have someone who’s a
pharmacist, you might have someone who’s a nurse, you might have
someone who has been unemployed for 15 year and was a skilled manual
worker, it doesn’t make any difference…it's not about professionals driving
us forward, because although people might come from very different
backgrounds they have a very good skill mix within, you know, from those
backgrounds, so it's very, very important to get the right mix and to make
sure that all the power implications are taken away”
To one respondent, shared power did not just mean those in power supporting
those without power, but actually ‘giving power away’, which would help to build
up trust and respect. There were those who felt that this recommendation made
helpful tips as to what actions should be taken, but in the main the view was held
30
that further advice on how to implement this recommendation would be greatly
beneficial.
o State HOW to identify and engage relevant community members
o Highlight ‘outset’ in the first bullet point to stress the importance of

this point
o Include a definition of ‘partnership’ – engagement through

partnerships may not necessarily be equal, but rather junior and
senior partners
o Trust and Respect (Recommendation 3)
Trust and respect was also identified as a key recommendation and was
understood to link closely to other recommendations such as long term planning
(rec 1) and levels of engagement and power (rec 2). Honesty and truth were felt
to be key factors in building trust and respect with communities, with trust and
respect being ‘paramount’ to effective community engagement.
“I think if you're trying to engage any kind of community at any level you
must attain high trust and respect from that community. Without that, no
intervention that you try to get into the community will work. So I think
that’s paramount really in terms of engaging communities.”
o State HOW to build trust and respect with communities –

respondents felt this would be a difficult recommendation to
implement; suggestions of how to build trust were provided:
• the importance of providing honest information about the

effectiveness of local services e.g. local hospitals.
• the importance of regular communication with partners

and target groups was also highlighted
31
o Clarify what the ‘appropriate methods’ to involve and reach out
to under-represented community groups are
o State HOW to feedback to communities – there were

respondents from community groups whose attempts to
feedback to communities through newsletters and meetings had
been unsuccessful.
• other respondents suggested building and networking

from existing relationships to help with feedback
o Avoiding pitfalls (Recommendation 4)
The coverage of pitfalls was felt to be useful and an important element of the
guidance. There were concerns raised regarding bullet point 1 – ‘Recognise that a
short-term focus on projects and initiatives can undermine efforts to secure long
term and effective community participation’ – in that funding on projects could be
short term, for example one year. Respondents suggested that they had to make
the best of the current situation, which could be projects with a shorter term
focus.
“‘Recognising short term focuses on projects and initiatives can undermine

efforts’ - I think that is all very well getting that type of guidance at a
local level but when a lot of the resources we have are only short term
resources…everyone can recognise that the environment that you are
working in is short term, and some grants are only lasting a year. I mean
you do the best you can with what you have got”
o Highlight this particular recommendation – could increase emphasis

by placing this recommendation ‘higher up’ (see section 4.1.1 or a
discussion on how the numbering of the recommendations was
perceived by respondents as relative importance)
o State HOW to deal with consultation fatigue
32
• There was a suggestion that using ‘joined up consultation’
could help overcome consultation fatigue. This was
described as identifying the joint consultation needs within
the local area to conduct consultations which serve the
needs of multiple organisations and reduce the amount of
overlapping consultations.
o Consider the risk of consulting with a ‘loud minority’ and

misrepresenting the views of the ‘quiet majority’
o Clarify what ‘adequate support’ is required to ensure individual

community group members are not overburdened.
o Infrastructure (Recommendation 5)
Training for those working with communities was considered to be very important,
but it was also stressed the resources need to be available for this training. There
were also concerns, particularly from those working at more strategic levels that
groups would not know who to contact for this training nor appreciate the time
involved in finding trainers.
“If you take recommendation five; infrastructure - ‘Provide training for

those working in the communities including community organisations’ and
there are a whole set of things. Now I happen to know where we might
commission that from, luckily enough, because we have been doing this for
a long time….but there is nothing there which says ‘this is not something
that you could just do in a half day, there are a range of specialist training
providers who could work alongside you to do this’, it just says ‘provide it’”
Director, Public Health Organisation
o State HOW to identify funding streams for training
o Provide information about where training can be commissioned from
33
o Cultural Shift (Recommendation 6)
This was a recommendation which respondents particularly felt they were already
working towards in their organisations and was considered ‘standard policy’. It
was felt that in the main, most people who work within this remit are aware of the
dangers and consequences of stereotyping, as stereotyping target groups can
reduce the effectiveness of initiatives and result in targets not being met.
“My general experience is probably 80 maybe 90 percent of the people who

work in the communities in one way or another are usually fairly sensitive
to the dangers of stereotyping, because they know that if they over-
stereotype or they overdo the sort of target group recognition they won't
be able to achieve their objectives”
Chief Executive, Housing and Homelessness Organisation
On the other hand, there were respondents who felt that there was a thin line
between identifying the needs of specific communities and stereotyping that
community. For these respondents, further advice was requested as to how
stereotyping can be avoided.
o State HOW to not stereotype members of the target community.

Respondents suggested the following ways to help reduce stereotyping of
target communities;
• provide diversity training
• engage directly with community groups to increase cultural

awareness
• ensure any consultation is wide enough to accurately reflect

the range of views of a whole community
• utilise the expertise of voluntary organisations who are often

experts in specific communities
• encourage target communities to engage with local strategy

boards to ensure a wide variety of views are represented
34
o Policy Development (Recommendation 7)
In the main, the principle of this recommendation was agreed with, but there
were respondents who worked for community organisations who felt that this was
not relevant to them. As stated within the guidance, this recommendation was
felt to be something which was of a ‘higher level’ to them to be dealt with by
‘decision makers and decision making bodies’.
o Clarify what polices are being referred to by the recommendation
o Partnership Working (Recommendation 8)
This recommendation was considered to be very relevant, but an area that

organisations were currently working towards through their own guidance and
polices. The importance of partnership working was consistently highlighted by
respondents and the benefits highly praised, with the idea of a formal agreement
considered to be useful in forming and maintaining partnerships.
“That’s quite useful in terms of say developing formal statement people

like having a compact with community groups and I think that’s quite
useful”
There were respondents from community groups and at strategic level who
expressed concerns as to how members of the community could be engaged in
partnerships.
o Provide templates for setting up partnerships, particularly with Local

Authorities
o State HOW to engage community members in partnerships
o Include a definition of ‘partnership’ – engagement through partnerships

may not necessarily be equal, but rather junior and senior partners
35
o PCT could help to raise profile of local groups to encourage partnerships
o Recognise that partnerships are more complex than just forming

‘compacts’.
o Training (Recommendation 9)
Training was a recommendation considered to be particularly key to community

engagement. Respondents highlighted the mutual benefits of using community
representatives to train those in local organisations. The importance of building
and developing the skills and capacity of community representatives was agreed
with, but concerns were raised regarding funds for this training.
“…and the fact that you do need to give people training, and there does
have to be funding and there does have to be back-up - it's amazing how
much it can cost people to be involved with things”
Chair, Patient and Public Involvement Forum
Training was also felt to be important to the forthcoming LINKS 6 . There were
respondents who felt there were important overlaps between this
recommendation and recommendation 5 – Infrastructure, with a suggestion
that the training recommendation simply repeated recommendation 5.
o State HOW to identify funding streams for training
o Provide information to help identify those in need of training and

training providers
o Highlight importance of tailoring training to the needs of your

audience
6
The Local Government and Public Involvement in Health Bill – currently going through Parliament – includes
plans to replace Patient Forums with Local Involvement Networks (LINks), which are expected to become
operational from 1st April 2008.
36
o Agents of Change (Recommendations 10-12)
There was a level of unfamiliarity with the term ‘agents of change’, but for those
who were familiar this set of recommendations was perceived as helping to bring
agents of change to the fore, and highlighting the importance of key individuals in
driving initiatives forward in communities. Concerns were raised around
maintaining the motivation of these ‘agents of change’ as respondents had
experienced volunteer agents, particularly those in poorer communities, losing
enthusiasm.
“It’s much better, particularly in poor communities, if you really are

considering having agents of change that they are paid agents of change”
Group Discussion 3, North East
o Provide a definition and introduction of what ‘agents of change’ are
o Consider incentivisation for community agents, for example paid time
o Ensure agents of change are monitored to help assess resource and

motivational needs of these agents
o Housing (Recommendation 13)
This recommendation was considered to be particularly important for those

working at ‘ground level’ and especially for those respondents who worked in
housing and homelessness. This recommendation was seen to tap into a
particularly vulnerable group of people through housing tenure acting as a proxy
for health inequalities.
“Housing tenure can be a really good proxy for some health inequalities so
it was good to see that”
Head of Public Health, Healthy Communities Organisation
o Increase priority of this recommendation, as housing is key to the basis of

community engagement (see section 4.1.1 for a discussion on how the
37
numbering of the recommendations was perceived by respondents as
relative importance)
o Highlight role of Local Authorities in this recommendation
o Area Based Initiatives (Recommendations 14-17)
Respondents agreed that area based initiatives are important and beneficial to
draw on the skill set of the local community. However, concerns were raised that
by being area based, this could exclude some communities and produce
‘neighbourhood inequality’.
“they don’t talk about the area based initiatives and they tend to create
further inequalities, it seemed to puzzle me. They have a community in
one area, then those in that area are going to get the intervention but
those outside are not, and automatically you create neighbourhood
inequality. This is not mentioned as a thorny issue to deal with”
Public Health Consultant, Primary Care Trust
There were also concerns that this recommendation could ‘reinvent the wheel’
as it was perceived that Local Authorities already had responsibility for
developing area based initiatives. There were respondents who, as they did
not work for Local Authorities, felt that this recommendation was not relevant
to them.
o Provide example of effective area based initiatives
o Discuss the possibility of creating ‘neighbourhood inequality’
o Do not use abbreviation ‘LSP’ as whilst the acronym is explained in

recommendation 15, it should be also be written in full in all
recommendations.
o Evaluation (Recommendation 18)
Evaluation and monitoring was perceived to be key recommendation and relevant

to all groups and organisations. Respondents felt that groups should prove the
effectiveness of their initiatives through close monitoring and evaluation of
38
performance. This was also stated with the caveat that effective initiatives can
take time before change is produced, and this should be taken into consideration
in evaluations. There were some questions as to what methods of evaluation
should be used and that good practice examples would benefit this
recommendation.
“It's the whole evaluation and value for money aspect of it and I felt there
was not a huge amount of information in this document around that. And
while I certainly wouldn't expect the document to come up with all of the
answers…it might also be useful to include a series of good practice
guidelines around evaluation and assessing impact.”
Community Manager, Community Action Project
The key criticism is that there was not enough evidence provided around what
good evaluation methods are, with the concern that poor methods will not identify
those initiatives that are working effectively/ineffectively. The guidance should
help to identify which tools are necessary to conduct good evaluation.
o Provide good practice examples of monitoring and evaluation
o Highlight that important to focus on quality of engagement in

evaluation as well as success in reducing health inequalities
o PCTs should take a lead in identifying areas where evaluation is

important
39
5 Style and format of the guidance
The content of the guidance and in particular the key areas covered by the
recommendations were in the main positively received. The area around which the
suggestions for improvement particularly centred was the style and format of the
guidance. Concerns were expressed that the layout and style of the guidance could
negatively impact on how readers responded to the guidance and ultimately how
effective it would be in improving health and reducing health inequalities. Issues that
were raised were focused around three areas, the intended audience, the layout of the
guidance and the language used within the guidance.
5.1 Intended Audience
Concerns were raised that the intended audience may be too broad for the current
version of the guidance. A key theme to emerge was that the guidance had been written
in an academic style which could prevent readers less familiar with such guidance from
digesting and making use of it. Respondents who were accustomed to receiving such
documents, such as those in strategic roles, did not show any particular difficulty but
suggested that community groups could struggle with the language and layout of the
guidance.
“I think, I suppose it depends who the audience is because it comes

across as quite academic, quite dry, its not very engaging in terms of, I
can’t imagine many of our community groups sitting down unless they’ve
got a particular health interest or remit I don’t think they would be sitting
down poring through it so to speak.”
Assistant Director, Community Partnership Organisation
Consistent with these concerns, there were respondents at all levels who found the
guidance difficult to engage with. Particular issues around the language and the layout
of the guidance were raised and are discussed in more detail in the following sections.
5.2 Language
The guidance was not considered to be a document that was easy to read, and there
were respondents at all but the highest strategic levels who reported needing to use
dictionaries to understand some words and needing to refer back through the document
to understand what acronyms represented. The language used in the guidance was felt
40
to be belong to a ‘specialist’ field and as such made the guidance feel like a ‘specialist’
document. This is important to note, as the content of the guidance was considered to
be particularly useful to those new to the concept of health inequalities and/or
community engagement, but the style of the language was thought to be a particular
barrier for these people. Similarly, there was also concern that this language could
exclude those members from community groups who are a key target for this guidance.
“I mean it seemed to me from the beginning that it looks as if it's been

written as guidance for people who are about to be or are already
engaged in these (areas) and people who would have a health service
language or a medical language…but if it was someone who hadn’t got
sort of youth work training or educational background somebody who
was actually running a fitness suite, who would have all sorts of
opportunities for creating these types of interventions, I think the
language might need a little bit of modification, it would need
explanation.”
The key concerns raised in reference to the language used in the guidance were:
o Use of ‘technical’ or ‘specialist’ language – this made the guidance feel as

though it was aimed at professionals or specialists. This was true across
the whole guidance, but ‘heterogeneity’ and ‘social capital’ caused
particular comment. It was suggested that an alternative version of the
guidance could be made available using only ‘plain English’. This version
should be specifically tailored to community groups and those individuals
who might be less familiar with the terms associated with health
inequalities and community engagement.
o Use of uninteresting language throughout the guidance - it was felt that

the language would not engage readers to try and implement the
recommendations in their organisation
o Language used can be confusing or ‘waffley’
“I think it could be summarised a lot easier because it just repeats

itself over and over again…It’s very waffley.”
41
o Need for careful definitions in the glossary – as a whole, the glossary was
considered very useful, but it was suggested that key terms such as
‘Community Engagement’ and ‘Community Development’ needed to be
carefully defined so as to include recognition of the current debates around
these terms.
o Language should be more cautious – there was a suggestion that the

guidance would benefit from being more cautious and should include more
‘caveats’ as the evidence base for the recommendations was not
considered to be conclusive by all.
The results of survey question 1 were:
Q1. Language easy to understand
14
Councillor
12
Disadvantaged &
10 vulnerable group service
8
Neighbourhood based
count
management and/or
community
6 empowerment
programme
PCT or LA with
4 community involvement
function
2
Other
0
Graph 3 - Responses to Survey Question 1 ‘The language used within the guidance and
the recommendations is easy to understand’.
42
group, 9 general groups, 2 groups representing older people and 1 ‘other’ group; Agree Strongly –
1 BME group; Disagree – 1 BME group, 1 general group and 1 group representing older people)
At first viewing the results do not appear to reflect the above opinion. The majority of
respondents (with 43 out of 49 answering ‘agree strongly’ or ’agree’) felt that the
language in the guidance was easy to understand. However, it is important to consider
two key factors:
Firstly, it is likely that respondents would have been answering this question based on
their views of the language used in the guidance. In the interviews and groups those
familiar with documents similar to the guidance found the language easy to understand
themselves, but expressed concerns that other people might have difficulties, particularly
community based organisations.
Secondly, it is possible that if respondents had found the language in the guidance
difficult to understand, they might have been less likely to read through the guidance and
complete the survey, and therefore their views may not have been reflected in the
survey.
5.3 Layout of the guidance
The layout of the guidance was felt to be characteristic of other types of guidance that
respondents had received. Respondents had general suggestions for improving the
layout, and in particular the length and presentation of the draft community engagement
guidance. The key issues raised reflect the recognition that this is a document
encouraging action from its readers. These are discussed further below:
o Length
A key concern that emerged was in relation to the length of the guidance. It was
suggested that the guidance was too long, and the intended audience for this
guidance would generally not have the time to allocate for reading the guidance. The
length of the guidance was also considered to be daunting (at 78 pages including the
appendix, and possibly longer in the final version) and it was considered that readers,
particularly community groups, may choose not to read the guidance simply based on
this. The length of the actual guidance and particularly the recommendations was
seen to be ‘adequately long’. However, the length and inclusion of the appendix and
glossary made the guidance seem overly long.
43
“I think any document which purports to be about taking forward
something quite practical, which has 37 pages of text and the rest of it
are appendix, I think doesn’t kind of sit right. It does make it feel much
more academic rather than something which is going to help take
forward organisations’ approaches to community development and
community engagement.”
Director, Public Health Organisation
Respondents stressed the importance of the guidance being a useable document, to

encourage readers to take action.
“[The] recommendations could usefully be presented in more punchy

concise fashion. it reads very much as an academic paper (which of
course it is) [respondent’s own parenthesis] rather than a practical
guidance checklist for organisations in the field to use”
Programme Manager, New Deal for Communities
Suggestions to improve the usability and length of the guidance were focused around
the presentation of the guidance and are discussed in more detail below.
o Presentation
As stated above, respondents placed emphasis on the guidance being a usable

document which encouraged readers to implement the recommendations. It was felt
that the current presentation of the guidance could prove to be a barrier to this, and
suggestions were made to develop the presentation. 8 recommendations were made:
o Include more visuals and diagrams to illustrate the recommendations being

made
o Start each recommendation on a new page to help readers identify specific

recommendations
o Have a title for each recommendation (for example recommendations 10-

12 and 14-17 which do not have individual titles)
o Include a table at the beginning of the guidance listing the

recommendations
44
o Place recommendation section at the front of the guidance – this section
was considered more important, and it was felt that the guidance should
be structured in terms of importance rather than the chronological
development of the guidance
o Create a summary or shortened version of the guidance. This could simply

be the recommendations plus a short introduction to community
engagement and health inequalities, with the full version guidance
signposted in this shortened version.
“Our user groups and community groups are less likely to read this
than the professionals. I think the professionals tend to get used to big,
weighty tomes from our sort of, from Central Government, from Local
Government, from the NHS and we tend to wade our way through
them, but I think you will find that small, user participation groups and
users and carers groups, are less likely to want to read through each
document.”
Partnership and Social Care Manager, Primary Care Trust
o Tailor the guidance for specific audiences – for example, include only those
recommendations that apply to that specific type of organisations (e.g.
Funding Bodies/Community Organisations)
o Provide the guidance in an alternative format for example videos,

podcasts, wall chart with bullet points.
45
6 Barriers to implementing the guidance
The majority of respondents in the small scale survey (28 out of 50 responses) felt that
there would be barriers to implementing the guidance and the recommendations in the
organisations they worked with. This was in response to question 6 – ‘I do not imagine
that there will be any barriers to implementing this guidance and the recommendations
within the organisation/s I work with’.
Q6 - There will be no barriers to implementation
12 Councillor
10
8 service
numbers

and/or community empowerment
4 programme
PCT or LA with community involvement
2 function
0
Other
agree agree disagree disagree
strongly strongly
Graph 4 - Responses to Survey Question 6 ‘I do not imagine that there will be any
barriers to implementing the guidance and the recommendations within the
organisation/s I work with’
(Note: In this graph, ‘Other’ represents the following communities of interest: Agree – 1 BME group
and 1 group representing older people; Agree Strongly – 1 group representing older people and 1
general group; Disagree – 2 BME groups and 8 general groups; Disagree Strongly – 2 general
groups, 1 group representing older people and 1 ‘other’ group)
Similarly, respondents in the depth interviews and group discussions identified a number
of potential barriers to implementing the community engagement guidance. These are
discussed below in combination with the open ended responses from the small scale
survey.
7 key barriers were identified and are discussed in more detail below.
1. Resources
Availability of resources was of key concern to respondents. Engagement and

consultation were considered to be highly demanding of both funds and time and so it
46
was suggested that specific funding should be made available to help implement the
recommendations.
It was felt that this funding needs to come ‘from the top’. A particular need for
funding was in order to address the training needs identified in the guidance.
There were respondents, particularly those from community groups, who felt that
community engagement initiatives would be in direct competition for resources in
their organisation (for example, providing services for clients). These respondents
felt that the aims of the guidance were laudable, but that they were unsure that they
would choose to expend resources on implementing the guidance recommendations
rather than providing the services of their organisation.
In considering the results from the small scale survey for question 3 – ‘The
organisation/s which I work with have adequate resources to implement the guidance
and recommendations’, mixed results were shown. A split was indicated between
agreeing and disagreeing with this statement, with 26 respondents marking ‘agree
strongly/agree’ and 23 marking ‘disagree strongly/disagree’.
Q3 - Adequate resources to implement
9
Councillor
8
7
6 Disadvantaged & vulnerable group
service
count
5
3 programme
2 PCT or LA with community involvement

function
1
0 Other
agree agree disagree disagree

strongly strongly
Graph 5 - Responses to Survey Question 3 ‘The organisation/s which I worth with

have adequate resources to implement the guidance and recommendations’.
group, 4 general groups and 1 group representing older people; Agree Strongly – 1 general
group, 1 group representing older people and 1 ‘other’ group; Disagree – 1 BME group and 6
general groups; Disagree Strongly – 1 BME group and 1 group representing older people)
47
One respondent who disagreed suggested that whilst their specific organisations
might have the resources, that other organisations, such as PCTs, would not.
“Although the NDC [New Deal for Communities] currently has adequate
resources to work in this way, from a health perspective, it seems that
PCTs do not, which is increasingly problematic as many NDCs are coming
towards the end of their funding. Despite policy shifts towards public
involvement, community engagement and health promotion, culturally
the NHS just does not seem ready for this either financially or in terms of
skills/willingness/confidence/capacity of staff.”
Community Health Project – Survey Response
2. Lack of ‘how to’ information in the guidance
As discussed in the recommendations section of this report, a key suggestion for

improvement was to state how each recommendation could be achieved. Specific
‘how to’ information could include ‘good practice examples’ of methods and initiatives
and directories of organisations and funding bodies. This was felt to be particularly
important for individuals and organisations less familiar with community engagement.
3. Style of the guidance
The language and presentation were felt to be potential barriers to respondents

engaging with the guidance and implementing the recommendations. This is
discussed further within section 5.
4. Promotion
Raising awareness of the guidance was felt to be a key enabling factor to successful
implementation of the guidance, and therefore a potential barrier to implementation
should the guidance be poorly promoted and marketed. Concerns were expressed
that should the guidance not be promoted effectively, that this in combination with
the other barriers listed could result in the guidance simply ‘sitting unread on people’s
shelves’. To overcome this, respondents suggested that that a dedicated website
should be set up and the guidance should be launched alongside a national service
48
framework to be sent directly to the directors of key organisations. It was also
suggested that the guidance could be used as a training tool to encourage usage.
“We get sent too much material that you have to make difficult decisions
about, you know, which one is going to receive sufficient attention for it
to be of any use? So that is a possible hindrance. I mean people who
receive these things through the post…if it lands on my desk then I’ve
got to consider it alongside all the other stuff, so the hindrance to its use
is going to be how well it's actually distributed…Websites seem to be a
way in nowadays, and whether it's not worth developing a website
especially for this issue in the beginning (so) that people could log onto
it.”
5. Willingness to implement guidance and recommendations
Concerns were raised that Local Authorities and Health Scrutiny Committees may not
take on the guidance due to associating the health inequalities with wider health
services, and as such may only ‘pay lip service’ to the recommendations. It was also
suggested that Health Scrutiny Committees are not in a ‘Community Engagement’
mode. It was felt that the guidance could benefit from explicitly stating how the
guidance related to local involvement networks.
“I have virtually no confidence in the Local Authority being able to

understand this kind of document….because it's, I know a lot of the, all
the LSP and I know a lot of the recommendations are related to
Councillors, Senior Council Officers and people in LSPs and so on and I
think there's a cultural issue around, this may just be something in our
local system but NICE guidance is nothing to do with Local Authority,
because it's about Health and that's the Health Service's business isn't it,
and perhaps one of the links that's missing in this document is the
connection between this guidance and local involvement networks.”
Community Manager, Community Action Project
A response from the small scale survey indicated that there were organisations who
had experienced barriers with Local Authorities regarding Community Development
initiatives. The response suggested that the respondent’s organisation had had to
49
manipulate the aims of Community Development initiatives in order to pass these
initiatives through their Local Authority.
“There are barriers to implementing this work both internally and

externally to our organisation. The local authority are very slow at
acknowledging a community development approach to work and we have
had to wrap all community development up in the ‘engagement’ banner
to implement community development 'by stealth' in the district.”
Primary Care Trust Manager – Survey Response
6. Support of key bodies and organisations
For the guidance to be effectively implemented, support from organisations such as

PCTs (in particular the Chief Executives) and PPI forums was considered to be key.
This embodied the view that support and commitment to the guidance and
recommendations needs to be shown from ‘top to bottom’.
7. Consultation apathy
Communities not wishing to be engaged in consultation was felt to be a potential

barrier to implementing the recommendations.
50
51
7 Improving health and tackling health inequalities
There were mixed views about whether the guidance had the potential to improve health
and tackle health inequalities. In the main, the recommendations were seen to have the
potential assuming that likely barriers to implementing the guidance have been
accounted for (particularly the barriers 1, 2, and 3 discussed in section 6). This view was
also shown in the small scale survey with the majority of respondents agreeing/agreeing
strongly (42 out of 48 responses) that the guidance had potential to tackle health
inequalities (question 5). Those who disagreed felt that the impact of the guidance could
be increased through providing ‘how to’ information and ‘good practice’ examples.
Q5 - Useful re. improving health & tackling health inequalities
12 Councillor
10
8 service
count
Neighbourhood based management

6
programme
4
PCT or LA with community involvement
function
2
Other
0
Graph 6 - Responses to Survey Question 5 ‘The guidance and the recommendations are
useful for organisations working with communities to improve health and tackle health
inequalities’.
group, 7 general groups, 1 group representing older people and 1 ‘other’ group; Agree Strongly – 1
BME group, 2 general groups and 2 groups representing older people; Disagree – 1 BME group and
1 general group)
The guidance was viewed as having the potential to encourage collaboration through
encouraging organisations to work towards the same set of recommendations.
“[The guidance] will actually gel the communities, I hope, gel the
communities together…we are all working for the same objective, we are
all working together to support each other”
Partnership and Social Care Manager, Primary Care Trust
52
It was also felt that consultation practice could be improved by adherence to the
recommendations, which would serve to reduce health inequalities and improve health in
the longer term. The guidance also was thought to have the potential to provide more
power to those being consulted, through encouraging organisations and groups to
implement the recommendations.
On the other hand, there were respondents at strategic levels as well as from community
groups who suggested that the guidance itself had limited potential to tackle health
inequalities as organisations were already working towards the implementation of the
recommendations through other more locally based guidance. Criticisms were also made
of Community Engagement as an approach. For example, there were respondents who
felt that ‘top down agendas’ were still important to implement health based initiatives,
rather than the ‘bottom up’ approach of community engagement.
53
8 Conclusions
This final chapter of the report outlines the key conclusions in relation to the main aims
of the research and ends with a brief discussion of some challenges faced in the
undertaking of this research.
8.1 Conclusions
The guidance was seen as a document which highlighted NICE’s support for community
engagement methods and gave credibility to the idea of ‘community engagement’. In
turn, it was felt that this would serve to reinforce the need for strategic and community
organisations to engage with local communities. On the whole, respondents felt familiar
with the issues and principles portrayed in the document; however this was one of the
key criticisms of the draft community engagement guidance. The guidance was not
perceived to be covering ‘new ground’ nor to provide concrete techniques to action the
recommendations that were made. Despite this, it was felt that the guidance could be
useful in providing a ‘blueprint’ for best practice for organisations to aim towards and a
useful tool for training those new to the concept of community engagement.
In the main, the guidance was considered to cover a subject area that was very relevant
to the organisations respondents worked with. Areas of the guidance where the
relevance was questioned included the language used and individual recommendations.
The format and language of the guidance was felt to be more relevant to those already
familiar with community engagement and community development and those in strategic
organisations compared with those who work directly with communities. It was felt that
the language could prove to be a key barrier to community groups using the guidance,
and as such could reduce the usefulness of the guidance.
The recommendations section was considered to be the most useful and relevant section
of the guidance, and would greatly benefit from ‘concrete’ suggestions around how to
implement each of the recommendations. Respondents suggested that examples of best
practice from other organisations would help them to work towards the implementation
of specific recommendations and the guidance as a whole. There were assumptions that
numbering the recommendations 1-18 suggested a hierarchy of importance. It was
asked that NICE clearly state their position on this and indicate whether the
recommendations were equally important or if there were recommendations that were
more significant to community engagement. Format changes were also suggested
around the recommendations section, with requests made for this section to be provided
as a ‘summarised’ version of the guidance.
54
Producing a summarised version of the guidance which provided concrete suggestions as
to how each recommendation could be implemented was considered to be key to the
success of the guidance in reducing health inequalities. Respondents felt the guidance
had the potential to reduce health inequalities and the social determinants of health, but
that the length of the guidance and the lack of ‘how to’ information would reduce the
potential impact of the guidance. In addition to this, availability of resources and the
language used within the guidance were also felt to be key barriers.
To help increase the effectiveness of the guidance in reducing health inequalities,

respondents felt the key barriers, as detailed within this report, need to be addressed.
On making these improvements to the guidance, the need for strong promotion of the
guidance was felt to be key. Concerns were expressed that should the guidance not be
well promoted, it could risk ‘sitting on people’s shelves’ and remain unused. To help
overcome this potential barrier, respondents suggested creating a dedicated website for
the guidance to provide advice to readers, and to launch the guidance alongside a
national service framework.
8.2 Challenges faced during the research
There were several challenges faced by the research team in the undertaking of this
research, each of which is outlined below, together with recommendations for future
research of a similar nature.
The timing of recruitment and fieldwork
The recruitment began in early August, and the fieldwork took place from August 23rd to
mid September. August is a difficult month for contacting people, as it is a popular time
for holidays. The research team also found that there were many potential respondents
who took holiday immediately prior to schools returning in early September. Not only did
the timing of the recruitment mean that people were difficult to get hold of, it also meant
that some people were unable to take part at all, as they were not available during the
fieldwork period. Further, when people returned from holiday they often felt that they
had to catch up with work commitments before they would be able to read the guidance
and take part in the research, again, meaning that they could not be available in the
fieldwork period.
We would recommend that future research avoids the August and early
September period if at all possible.
55
The length and complexity of document
The guidance document itself proved to be a barrier to some people taking part. There
were many instances of people who had agreed to take part in interviews contacting the
research team to cancel when they opened the guidance document (which was sent in
PDF format). The document was seventy eight pages in length and was accompanied by
a one page introductory document which asked respondents to prioritise reading the
Recommendations (a total of seventeen pages). Researchers also found that people who
had been booked in for interviews were not there when they called, and who could not be
re-recruited to the research when contacted later – often citing lack of time to read the
document as a reason. Other people had only opened the document a few minutes
before interviews were due to take place (although they had been asked to read the
guidance the day before the interviews), so felt that they could not read and assimilate
the information in time for the interviews.
The complexity of some of the language also appeared to discourage some people from
taking part. This is particularly worrying in terms of ensuring participating from as wide
a group of people as possible. The issue of the complexity of the language was brought
up as a potential problem by respondents in interviews, who thought that there were
likely to be some community groups who would have difficulty using the guidance
because of it.
We would recommend considering using only the recommendations section for

future evaluations of draft guidances to overcome some of these issues.
The length of time available to undertake the research
This research was commissioned to be completed in just under one month from the
guidance being available to send to respondents. Although the length of time itself
seems reasonable to undertake forty interviews, four focus groups and a small survey,
the timing of the research and the length and complexity of the guidance (see above)
meant that difficulties were encountered in completing the research within the time
available.
We would recommend that if possible future research should allow at least six
weeks for the fieldwork to be completed, even if the recommendations above
regarding the timing of the research and the complexity of the guidance document
are taken up by NICE.
56
Paucity of response to survey
The response to the survey was 9.67%, which was particularly disappointing as the
sample was drawn up by the researchers, who sought out organisations and, wherever
possible, named individuals to whom to address the email mailing out the questionnaire.
In the research team’s original proposal for this research there was an assumption that
approximately half of the sampling frame for the survey would be supplied by NICE,
however this was not possible. The research team had thought that they would be able
to achieve approximately 153 responses from a sampling frame of 425 (an approximately
33% response rate) – with a higher response rate from organisations which had already
had some engagement with NICE (that is, from sample supplied by NICE). As NICE were
unable to supply more than a very few contacts for the survey the BMRB team drew up a
sampling frame based on internet searches. Although the sampling frame was relatively
robust in terms of types of organisations and having named individuals, there was no
way of knowing whether organisations had had any kind of engagement with NICE.
Approximately twenty five emails ‘bounced’ when sent, which was a lower than expected
number from a sample drawn in this way (as contact details on the internet can quickly
become out of date).
The low response rate for the survey means that not as many different types, or
locations, of organisations participated in the research as was hoped.
We would recommend that future research using a survey technique considers

using a sampling frame which NICE itself produces from organisations which have
been in contact with, or are known to, NICE.
If the previous recommendation, to use a much smaller document containing only

the Recommendations, for future evaluations, this might also increase the
response rate for surveys.
57
Appendices
Appendix A – Sample breakdown
i – Depth interviews
Role Organisation Name Location Community of

Interest
Head of Public Health Healthy Community North East General
Organisation
Manager Community Health North East Women, BME, Parents
Project
Community Local Authority North East CYP, Older, General
Engagement Officer
Chair PPI Forum North East General
Manager Surestart North East Women, CYP
Drug Action Team Co- Local Authority North East Women, BME, CYP,
ordinator Drug Users
Manager Youth Offending Team North East BME, CYP
Manager Housing and North East CYP
Homelessness
organisation
Health Provision, Primary Care Trust North East Older, Disability
Commission & Care
Development Manager
Associate Director Teaching Primary Care North East General
Trust
Programme Manager New Deal for North East General
Communities
Head of Community Primary Care Trust North East General
Engagement
Children’s Health NHS – Public Health North East CYP, Disability
Manager Directorate
Mayor Local Authority North East General
Children’s Services Local Authority North East CYP
Manager
Director Social Enterprise North East General
Organisation
Councillor on Health Local Authority North East General
Scrutiny Committee
Patient & Public Primary Care Trust North East General
Involvement
Management
Assistant Planning and Primary Care Trust North East General
performance manager
Manager Partnership North East General
Organisation
Patient Involvement Primary Care Trust North East General
Manager
Community Manager Community Action North East General
Project
Drug Action Team Co- Local Authority South West Drug Users
ordinator
Chair of Health Scrutiny Local Authority South West General
58
Role Organisation Name Location Community of
Interest
Panel
Chair Patient and Public South West General
Involvement Forum
Director of Children’s Local Authority South West CYP
Services
Chair of Health Scrutiny Local Authority South West General
Committee
Assistant Director Community South West General community
Partnership
Organisation
Public Health Primary Care Trust South West General
Consultant
Strategic Head Local Strategic South West General
Partnership
Chief Executive Housing and South West CYP
Homelessness
Organisation
Director Public Health South West General
Organisation
Public Involvement Primary Care Trust South West General
Specialist
Corporate Business Primary Care Trust South West General, Mental
Manager of Partnership Health
and Social Care
Deputy Director Public Health South West General
Organisation
Area Manager Mental Health South West Mental Health
Organisation
District Nurse Team Primary Care Trust South West Disability, Older
leader
Director Housing and South West Neighbourhood
Homelessness renewal
Organisation
Head of Housing & Local Authority South West General
Residential Services
Carer Coordinator Disability Organisation South West Disability
59
ii – Group Discussions
Group no Role Organisation name

Group 1 – Chief Executive Officer Disability Inclusion Network
South West
Project Manager Community Health Organisation
Project Officer Community Health Organisation
Project Officer Healthy Living Organisation
Planning Manager Community Development
Organisation
Project Manager Community Development
Organisation
Trustee Disability Organisation
Group 2 – Acting Director Health Promotion Charity

South West
Chief Executive Children and young people
organisation
Project Monitoring Officer Community Partnership
Project/Partnership Manager Mental Health Organisation
Youth and Community Project
CEO Drug and Alcohol Organisation
Deputy Assistant Director Partnership Organisation
Coordinator Disability Charity
Group 3 – Community worker Refugee Organisation

North East
Developmental Coordinator Community Forum
Manager Older persons Organisation
Manager Health and Well Being Organisation
Director Disability Organisation
Director Disability Organisation
Chair Community Network
Group 4 – Chief Executive Voluntary Service Organisation

North East
Manager Women’s Health Organisation
Health Promotion Manager Primary Care Trust
Manager Sexual Health Service Primary Care Trust
Head of Community Local Authority
Regeneration and Culture
Project Manager Healthy Living Centre
Operations Manager Older Persons Organisation
Chief Executive Health and Well Being Organisation
60
61
Appendix B – Invitation letter
MidCity Place
71 High Holborn
London
WC1V 6NA
Tel: 020 7067 5800

Fax: 020 7067 5801
Email: nice@nice.org.uk
www.nice.org.uk
Dear
I am writing to invite you to participate in an evaluation of the draft community engagement

programme guidance. The Centre for Public Health Excellence (CPHE) at the National Institute
for Health and Clinical Excellence (NICE) is developing guidance that examines the impact of
community development and engagement methods and approaches on improving health and
reducing health inequalities.
NICE have commissioned the British Market Research Bureau (BMRB) to undertake the
evaluation and the study will involve interviews with members of staff from a number of
organisations which are involved in working locally with communities and vulnerable groups.
The purpose of the research is to explore views of the draft community engagement
programme guidance. In particular, this research will explore the relevance of the guidance
to the current practices of those who work with communities and vulnerable groups, and the
potential for the guidance to tackle health inequalities. Furthermore the research will explore
factors which may hinder implementation and delivery of the guidance with specific reference
to the roles and capacities of organisations working with communities and vulnerable groups.
We would like to invite you to participate in an interview with a BMRB researcher. It may be
that you feel there is another individual who is better placed within your organisation to
comment upon these issues, in which case please recommend this person. Each interview will
last for up to an hour and will be strictly confidential. BMRB will send you a summary of the
draft community engagement programme guidance in order that you can familiarise yourself
with the document prior to the interview. BMRB will call you in the next few weeks to arrange
an interview at your convenience between the dates of 24th August and 4th September 2007.
This research provides the opportunity to shape the final guidance for the community
engagement program. Participation in the research is entirely voluntary but I would very
much encourage you to take part and would appreciate your participation. If you would like
to speak to a BMRB researcher regarding this research please contact Claire McAlpine (email:
claire.mcalpine@bmrb.co.uk, telephone: 0208 4334394).
Thank you very much in advance for your help.
Anthony Morgan
Associate Director, CPHE
62
63
Appendix C –Information Sheet for Interviews/Groups
Community engagement and community development

methods and approaches to health improvement
Introduction
Thank you for agreeing to participate within this research. This document briefly
introduces the draft guidance and signposts you to parts of the guidance we would
recommend you particularly familiarise yourself with.
The guidance sets out preliminary recommendations for NHS and non-NHS professionals
who have a direct or indirect role in – and responsibility for – community engagement
and community development. This includes those working in local authorities and the
community, voluntary and private sectors.
Ideally we would like to receive your feedback on the whole

document, however, we realise that you might not have time to
study it in detail before your interview.
We feel that Section 4 (Recommendations, pages 12-29) is

particularly important, followed by Sections 2 and 3 (‘Public
Health Need and Practice’ and ‘Considerations)
Please note that recommendations 1–7 cover the essential conditions required if
community engagement/development activities are to be undertaken. Recommendations
8–18 relate specifically to interventions/initiatives which aim to promote health or
address the social determinants of health.
If you have any questions about this research, please feel free to contact Claire McAlpine
(claire.mcalpine@bmrb.co.uk, 0208 4334394).
64
65
Appendix D – Topic Guide
45106553
Sep 2007
Revised Final
Topic Guide
NICE Community Engagement Guidelines
The aim of this project is to test the draft community engagement programme guidance with
people involved in working with communities and vulnerable groups.
Specifically the project will:

• evaluate the relevance and use of the guidance with regard to:
o people’s current practice
o the guidance’s potential to tackle health inequalities
• explore views the guidance’s usefulness, relevance and potential impact on health
inequalities
• explore the factors which could help or hinder the guidance’s implementation and delivery
1 INTRODUCTION
• About BMRB
• Nature of the Research; study for NICE
• Emphasise confidentiality; explain audio recording (and observer, if present)
• Length: face to face interview 60 minutes; telephone interview 40 minutes; group
discussion 90 minutes
2 AGENDA FOR DISCUSSION

• Ascertain whether guidance has been read
• Give background:
• The guidance is for all those with responsibilities for community engagement and
community development-working in local authorities, the NHS, community, voluntary
and private sectors
• The final guidance is due to be issued by NICE in early 2008 –to the NHS and local
authorities, and others. The guidance will be supported by implementation advice and
tools (such as a slide set and costing guide)
• The guidance will provide national standards to enable the NHS and local
government to meet their objectives and targets for improving the wellbeing of
communities. The guidance will be used by the Healthcare Commission and Audit
Commission for monitoring the performance of these agencies.
66
• Will begin by getting a brief overview of respondent, their background and their
organisation
• Will then move on to mainly discuss the Recommendations
3 GENERAL BACKGROUND OF RESPONDENT

(Keep brief – no more than five minutes. NB. If you have detail in your Depth
Confirmation Form please use this and check against it to save time – only
probe where more detail is needed or information is needed)
• Type of organisation the person is from (Local authority, health sector, voluntary
sector etc)
• Role within organisation
Probe on whether:
• Commissioner/ manager/ funder?
• Practitioner/ Community development worker?
• Community member/ representative of the community
• Client group (e.g. women’s health, older people, disability etc. etc.)
• Field of expertise
Probe on:
o Health improvements (e.g. via planning, design, delivery and
management of health promotion projects
o Social determinants of health (planning, design, delivery or
management of projects on wider determinants of health such as
housing, employment
o Other - working with community groups/members
• Involvement with (other) community groups – which/why/how
• Involvement with (other) stakeholder groups – which/why/how
4 THE DRAFT RECOMMENDATIONS
Note: If respondents wish to discuss specific recommendations, that is fine,

but you could also cover them in groups:
• Recommendations 1–7 cover the essential conditions required if community

engagement/development activities are to be undertaken
• Recommendations 8–18 relate specifically to interventions/initiatives which

aim to promote health or address the social determinants of health
Specifically the recommendations cover:

1: Long term planning
2: Levels of engagement and power
3: Trust and respect
4: Avoiding pitfalls
5: Infrastructure
6: Cultural shift (NB see below on this, which needs covering specifically)
7: Policy development
8: Partnership working
67
9: Training
10-12: Agents of change
13: Housing
14-17: Area based initiatives
18: Evaluation
Importance of recommendations
• Which recommendations (or sets of recommendations) are most important to
community engagement and tackling health inequalities and WHY
Note to researcher: Please ensure that you allow at least 10 mins for this probe.
If a group, encourage respondents to debate which recommendations are important
if there is any disagreement.
Relevance
• Explore relevance of the recommendations to current practice/field of expertise
and relevance of each of the draft recommendations
o Explore if some recommendations are more relevant than others – what
makes this so
o What would make these recommendations more relevant to you/your
practice
Usefulness
• Thoughts on whether anything missing in recommendations
• Explore usefulness of the recommendations to current practice/field of expertise
and usefulness of each of the sections of the draft recommendations
o Explore if some recommendations (or sets of recommendations) are
more useful than others – what makes this so
o What would make this guidance more useful to you/your practice
• Thoughts on positive and negative aspects of the recommendations
Tackling health inequalities

• Thoughts on consequences of the recommendations for tackling health
inequalities (positive and negative aspects)
• Thoughts on what would be the outcomes for health inequalities if these
recommendations were implemented
Improving health
• Thoughts on consequences of recommendations for improving health
• Thoughts on what would be the outcomes for improving health if this guidance
was implemented
Factors which might aid effective implementation

• In their practice/field of expertise
• For others
• Who would you like to see support the recommendations
Factors which might impede effective implementation
68
• In their practice/field of expertise
• For others
• How could these barriers be overcome
Views on how recommendation 6 might be achieved

o what actions/initiatives are suggested
Note to researcher: Please refer respondent/s to recommendation 6 ‘Cultural shift;
What action should they take’ - “Do not stereotype members of the target
community…”
Sequencing
• Thoughts on the sequencing of the recommendations – is it correct / if not, why
not? Suggestions?
Intended target audience / who should take action

• Views on the people/groups identified under the ‘intended target audience’ and
‘who should take action’ for each recommendation – are these correct / if not,
why not? Suggestions? [[Researcher Note: NICE are particularly keen to ensure
that the guidance is seen as working with communities rather than doing to a
community]]
5 GENERAL VIEWS ON THE DRAFT GUIDANCE
• Views on draft recommendations

Probe on:
o Language
o Length
o Presentation
• Explore relevance of considerations section, recommendations and gaps

sections
6 ANY OTHER COMMENTS
7 THANK AND CLOSE
69
Appendix E – Survey questionnaire
NICE draft community engagement guidance

Short Questionnaire
Thank you for agreeing to complete this short questionnaire. There are 6
questions which should take approximately 5-10 minutes in total to
complete.
This questionnaire gives you the opportunity to give your views and feedback on
the draft community engagement guidance.
It is important that you have familiarised yourself with the draft community
engagement guidance prior to completing this questionnaire. Please find a
summarised version of this guidance attached to the email you were sent by
BMRB.
Please answer the questions below by indicating your agreement/ disagreement

with each statement. Return your completed questionnaire to Claire McAlpine
(claire.mcalpine@bmrb.co.uk) by the 7th of September 2007.
Confidentiality – please note that your answers to these questions will

be kept strictly confidential. NICE will not be made aware of which
individuals have participated within this research.
If you have any questions about this questionnaire or the research in general,
please feel free to contact Claire McAlpine at the above email address.
70
Q.1 The language used within the guidance and the
recommendations is easy to understand
Please tick only one answer
Agree strongly / Agree / Disagree / Disagree Strongly
explain your answer:
please type your answer here
Q.2 The guidance and the recommendations are very relevant to

my current practice and the organisation/s which I work with
71
Q.3 The organisation/s which I work with have adequate
resources
Please to implement
tick only one answer the guidance and recommendations
Q.4 I am satisfied that the guidance and the recommendations

are relevant to the needs of all communities
Q.5 The guidance and the recommendations are useful for

organisations working with communities to improve health and
tackle health inequalities
72
Q.6 I do not imagine that there will be any barriers to

implementing this guidance and the recommendations within
the organisation/s I work with
Please complete the following details below:
Your name:
Organisation name:
Address:
Postcode:
73
Telephone No:
Email address:
Community of interest:
North East North West
Yorkshire East General Women

and Humber Midlands
BME Groups Children and
West East of Young People
Midlands England
Disability Older people
London South East Groups
South West Other: please

state
Region:
Locality:
Service Type: Many thanks for your

participation within this
research.
Neighbourhood PCT or LA
based with
management community
and/or involvement Could you please email your
community function
completed questionnaire by the
empowerment
programme 7th of September to
claire.mcalpine@bmrb.co.uk.
Councillor Young
Peoples
Service
Alternatively, you can post this
Disadvantaged Other: please
questionnaire to: Claire
and vulnerable state
group service McAlpine, BMRB Social
Research, Ealing Gateway, 26-
30 Uxbridge Road, Ealing, W5
2BP.
74
Appendix F – Information Sheet for Survey
Community engagement and community development

methods and approaches to health improvement
Introduction
Thank you for agreeing to participate within this research. This document briefly
introduces the draft guidance and signposts you to parts of the guidance we would
recommend you particularly familiarise yourself with.
The guidance sets out preliminary recommendations for NHS and non-NHS professionals
who have a direct or indirect role in – and responsibility for – community engagement
and community development. This includes those working in local authorities and the
community, voluntary and private sectors.
Ideally we would like to receive your feedback on the whole

document, however, we realise that you might not have time to
study it in detail before completing the questionnaire.
We feel that Section 4 (Recommendations, pages 12-29) is

particularly important, followed by Sections 2 and 3 (‘Public
Health Need and Practice’ and ‘Considerations)
Please note that recommendations 1–7 cover the essential conditions required if
community engagement/development activities are to be undertaken. Recommendations
8–18 relate specifically to interventions/initiatives which aim to promote health or
address the social determinants of health.
If you have any questions about this research, please feel free to contact Claire McAlpine
(claire.mcalpine@bmrb.co.uk, 0208 4334394).
75

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A BMRB report for:

Prepared for: National Institute for Health and Clinical Excellence

Prepared by: Claire McAlpine, Sue Clegg and Darren Bhattachary

Telephone: 020 8433 4394

Part of BMRB Limited (British Market Research Bureau)

BMRB is ISO9001:2000 and ISO 20252 accredited.

Executive Summary ............................................................................................... 4

2 Research design ............................................................................................. 10

3 Views on the Guidance as a whole.......................................................... 18

5 Style and format of the guidance ............................................................ 40

6 Barriers to implementing the guidance ................................................ 46

7 Improving health and tackling health inequalities .......................... 52

 40 interviews (a combination of face to face and telephone interviews)

 4 group discussions (2 each in the North East and South West)

50 responses to the survey were received.

General views on the guidance

 Long term planning (recommendation 1)

 Levels of engagement and power (recommendation 2)

 Trust and respect (recommendation 3)

 Avoiding pitfalls (recommendation 4)

 Partnership working (recommendation 8)

 Evaluation (recommendation 18)

 Highlighting the importance of education in health improvement throughout the

 Emphasising the importance of honest feedback to the community regarding

 Providing advice on how to engage with vulnerable client groups

 Including all communities of interest

 Recognising the importance of volunteer workers

 Reducing repetitiveness of the recommendations

 Having consistency regarding ‘who should take action’

 Providing titles for all recommendations

Style and format of the guidance

Barriers to implementing the guidance

Other barriers were:

 Lack of ‘how to’ information

 The length of the guidance and the language used

 Promotion of the guidance – this was highlighted as a potential barrier if the

 Lack of support from key bodies and organisations

Improving health and tackling health inequalities

1.1 Background to the research

1.2 Research aim and objectives

Specifically the project’s objectives were to:

1.3 Report outline

2.1.1 Qualitative fieldwork

Numbers of interviews and groups

Conduct of the interviews and group discussions

All interviews and group discussions were recorded and transcribed.

The analysis of qualitative material using Matrix Mapping

Material collected through qualitative methods is invariably unstructured and unwieldy.

2.1.2 Small scale survey

Conduct of the survey

The survey questions

The survey questions were as follows:

Data was also collected on respondents, to classify answers according to type of

Please see Appendix E for a copy of the survey questionnaire.

Service type (or role) Number

The regions represented by the survey participants were:

Community of interest Number

Analysis of the survey data

The use of quantitative data in this report

3.1 Usefulness of the draft community engagement guidance

Group Discussion 4, South West; Somerset

“Although there is a brief reference to the distinctiveness of community

40 interviews (a combination of face to face and telephone interviews)

4 group discussions (2 each in the North East and South West)

Long term planning (recommendation 1)

Levels of engagement and power (recommendation 2)

Trust and respect (recommendation 3)

Avoiding pitfalls (recommendation 4)

Partnership working (recommendation 8)

Evaluation (recommendation 18)

Highlighting the importance of education in health improvement throughout the

Emphasising the importance of honest feedback to the community regarding

Providing advice on how to engage with vulnerable client groups

Including all communities of interest

Recognising the importance of volunteer workers

Reducing repetitiveness of the recommendations

Having consistency regarding ‘who should take action’

Providing titles for all recommendations

Lack of ‘how to’ information

The length of the guidance and the language used

Promotion of the guidance – this was highlighted as a potential barrier if the

Lack of support from key bodies and organisations

That the sections seemed very academic, and therefore off-putting

That more rigour was needed