Integrated Home Care Programs for frail older people: evidence from a systematic review

Abstract

Background Intervention-generated inequalities, whereby those most likely to benefit from public health interventions are least likely to receive them, are an acknowledged concern. Among socially excluded groups, mistrust often influences decisions about engagement with health services, likely contributing to what has been termed the ‘inverse prevention law’. Methods Findings from two research projects are drawn upon in order to produce lessons around how trust can be developed between public health practitioners and excluded groups. The first project is a realist synthesis of the evidence on how outreach improves the health of Traveller Communities. The second is an evaluation of intensive welfare advice services for groups experiencing complex circumstances, with findings from qualitative interviews with clients and staff members reported on in particular. Results Concrete examples are provided of the ways trust was negotiated between practitioners and members of excluded groups. In both contexts studied, the factors influencing trust echoed reports in the literature. This included: security; number of similarities; alignment of interests; benevolence; capability; communication; and integrity/predictability. However, the specific ways that practitioners and community members enacted these factors varied across the studies. For example, similarities could refer to being of the same ethnicity, having similar life experiences and/or the alleviation of stigma by presenting circumstances as universal or ordinary. Conclusions Comparing and contrasting processes of trust development for two distinct forms of service provision and population groups has illuminated the variety of ways in which components of trust ‘play out’ and are worked at in practice. It is important for public health practitioners to consider all of the components of trust noted when working to engage with excluded groups. Key messages: Building trust is key when seeking to engage with excluded groups. The ways trust is demonstrated and assessed depends on the particular context and characteristics of truster and trustee.