Co-development of a culturally and contextually sensitive community-based intervention to promote health and wellbeing in the asylum seeking and refugee community.

Research questions How can a culturally and contextually sensitive, community based creative intervention, co-developed using a participatory approach, promote health and wellbeing among asylum seekers and refugees? What are the barriers and enablers associated with its implementation, acceptability, scalability, and sustainability; and what is the most appropriate setting for such an intervention? Background Asylum seeker and refugees (ASR) are underserved in healthcare and research. Current interventions are not culturally and contextually sensitive, contributing to worse health outcomes. Multiple systematic reviews highlight the impact of the wider determinants of health for ASR and the need for targeted culturally and contextually sensitive health promotion interventions, co-designed with communities. Asset-based approaches to health promotion acknowledge the active role of people in creating health, their crucial role in bringing about change, and that health arises from interplay between people and their context. Participatory Aim To develop and evaluate a culturally and contextually sensitive, community-based creative intervention to promote health and wellbeing in the asylum seeking and refugee community. Objectives: 1. Synthesise current evidence on creative health and wellbeing promotion interventions for ASR, including culturally sensitive interventions. This will include identifying barriers to and enablers of implementation. 2. Develop and refine a health and wellbeing promotion intervention which is contextually and culturally sensitive to ASR by exploring creative and participatory approaches. 3. Pilot and evaluate the acceptability (including cultural sensitivity) and how to optimise the sustainability of the intervention. This will also identify outcome measures to inform full evaluation and future scale up in primary care or community settings. and creative approaches offer an opportunity to provide an asset based approach to health promotion. Methods Following the MRC guidance on complex intervention design, a qualitative narrative synthesis of primary care and community delivered health and wellbeing interventions in ASR, including culturally adapted and creative interventions will be conducted. This will include identifying barriers to and enablers of implementation (and how meaningful outcomes can be measured). Significant groundwork has been undertaken with a community partner over the last two years. A stakeholder panel will be convened with primary care staff and people with lived experience of seeking asylum, from a group of Sanctuary Ambassadors, to review the evidence from the narrative synthesis and co-develop a health promotion intervention for use in community or primary care settings. This will be tested in two sites - Norwich and East London. Questionnaire and semi-structured interviews will assess practicability, impact on health literacy, cultural acceptability, and plans for future scale up. Timelines Estimated completion time is 51 months at 0.7 WTE (including 0.2WTE clinical work) Anticipated impact and dissemination This will result in a culturally and contextually sensitive intervention to promote health and wellbeing in the ASR community which has been refined by a process of co-development to ensure acceptability and scalability and has potential for future testing and scale-up. Results will be disseminated widely to the ASR community and via peer reviewed journals, policymakers and practitioners and potential scale up explored via the City of Sanctuary national network.