Background: Grŵp Cynefin, a North Wales housing association, aspire to offer a social prescription (SP) service within an innovative health and well-being Hub, currently being planned in the Nantlle Valley, North West Wales. In line with the requirement of Welsh Government policy to engage with service users when developing health services, Grŵp Cynefin want to engage the community in the development of the SP intervention through co-design and co-production.
Aim: The aim of the research was to gather information about co-production and to engage with the residents of the Nantlle Valley to gather perceptions regarding the need for co-produced SP interventions to meet the well-being needs and requirements of the community.

Methods: A systematic review was conducted to examine the evidence in developing SP interventions that applied a co-designed /or co-productive approach to improve well-being outcomes in a community setting. Applying the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines, eight qualitative studies were selected for inclusion in the review and a narrative thematic synthesis of the results was conducted.

In addition, a qualitative study was conducted based on the systematic review results to gain a grassroot level perspective of the Nantlle Valley residents’ perceptions of SP interventions. A convenient sample (n=16) of community members were recruited by various means and data was collected through 4 focus groups. Drawing from the principles of citizen assembly deliberations and future design in developing sustainable strategies, a novel approach was applied to the focus groups. The “Today Groups” deliberated on the well-being of community today, and the “Legacy Groups” deliberated on the well-being of future generations in developing SP interventions and the well-being Hub as a whole. The focus groups results were analysed through thematic analysis.
Results: The systematic review results suggested that engaging community members in SP development through co-designed and co-produced approach empowers service users and ensures their buy-in consequently generating sustainable well-being outcomes. The results of the focus groups imply a need for such an approach to the development of additional SP in the Nantlle Valley. This is due to unaddressed social and economic determinants of health as well as a weakened core economy. The results also demonstrate that SP interventions are an integral part of establishing a holistic health service to ensure a resilient and sustainable healthy community. However, the results of the systematic review and focus groups also suggest common barriers that could hinder the co-production of SP interventions. The identified obstacles in taking a co-production approach highlight the importance of ensuring effective leadership, sufficient resources along with suitable evaluation framework to co-produce sustainable SP intervention within community settings. The results of the focus groups also imply the potential of the well-being Hub initiative to be a catalyst not only for improving the health and well-being of the community, but to alleviate long-term health inequalities facing future generations of the Nantlle Valley.

Conclusion: This Thesis concludes that although there are current SP interventions in the Valley, there is a need for additional co-produced social prescribing interventions to improve well-being outcomes in the Nantlle Valley. The results from this study indicates that a co-produced approach should be applied to the development of SP interventions within an implementation science framework with evaluation built in from inception phase, to ensure the sustainability of the intervention. The evidence from this study also concludes that taking a short and long-term thinking deliberation approach to focus groups is effective in addressing the needs of present-day citizens and recognises local and long-term challenges. In addition, evidence demonstrates that such an approach inspires interventions that can shape healthy, sustainable communities.