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Background

Social innovation in health refers to the community-engaged process that connects health improvement and social change. The aim of this study was to develop a consensus statement on core learning competencies in social innovation in health and pilot them as part of a participatory training workshop.

Methods and findings

A modified Delphi Process aggregating data from a scoping review, global open call, and participatory process was organized. Participants were recruited from low, middle, and high-income countries with a range of social innovation experiences. Statements focused on social innovation in health core competencies for learning. Consensus was determined using the RAND/UCLA Appropriateness method. After expressing interest in the project, 68 individuals received the survey. 46 participants completed the first survey, and 35 completed the second. All 28 statements reached consensus, and based on the results of this first survey, some statements were added, amended, and merged to reach 30 consensus statements in the second survey. Competencies were categorized into skills, mindsets, and knowledge. Twenty-five statements had a median Likert rating score of >8 indicating strong agreement. Some competencies reached higher levels of agreement. This included community engagement, which can leverage the collective knowledge and problem-solving abilities of a diverse group of individuals to tackle complex challenges; social entrepreneurship skills including business model knowledge, securing funding, team building, and knowledge of intersectional issues and health inequities. Twelve competencies were then piloted as eight one-hour online workshops, which assessed the feasibility of developing them through online open-access social innovation training sessions. Afterwards,137 participants completed a survey rating their competency on a scale from 1 (not competent) to 5 (very competent),most reported a significant 1-point improvement including in entrepreneurship and understanding intersectionality.

Conclusion

The results from this study will inform the development of a WHO/TDR conceptual framework which will have implications for training program design and policy.

Despite a universally accessible and high-quality welfare system, disparities in health and wellbeing persist between families who have migrated to Sweden and the native population. The South African Mentor Mother programme, a social innovation for maternal and child health among socially disadvantaged communities, was transferred and adapted to benefit mothers and pregnant women with experiences of migrating to Sweden.

This thesis aims to explore the adaptation, implementation and further development of the South African Mentor Mother programme in two locations in Sweden, based on professional and lived experience among various groups of stakeholders.

In Study I, three workshops and eleven interviews were held with stakeholders to explore central aspects of the adaptation process. These aspects entailed prioritising social determinants of health over health behaviour change, using indirect mechanisms and social ripples to achieve change, prioritising referring clients over intervening directly, recruiting peer supporters with competencies responding to a heterogeneous socio-cultural context, and allowing flexibility in programme content and methods.

In Study II, nineteen interviews with different stakeholders and digital field logs of peer support meetings (n=1,294) were used to evaluate the implementations of the programme. Contextual factors of importance included institutional mistrust, gender norms, unpredictable funding, and the organisation's third sector affiliation. Peer supporters prioritised linking clients to welfare services over educational intervention components, and sometimes experienced blurring between professional and personal roles. Practical support and trustful relationships emerged as important entry points to support more sensitive issues. 

In Study III, the photovoice method was used to conduct a focus group discussion and six interviews with Mentor Mothers and their coordinator in Gothenburg, exploring how they developed empowerment strategies perceived to be relevant, feasible and effective. These strategies consisted of various aspects of using both informative, practical, psychosocial and motivational support to meet community health and social needs.

In Study IV, twenty-one interviews with Mentor Mothers, client mothers and other stakeholders were conducted to explore the emergence and management of mistrust in welfare services in Gothenburg. Mistrust was described to arise through rumours, unclear interactions with services, and lack of familiarity with the welfare system. Mentor Mothers used various strategies to build trusting relations with clients, which enabled them to promote institutional trust through information and humanisation of service providers.

This thesis illustrates how innovative community-based solutions to complex societal problems can be transferred between contexts, implemented and further developed to ensure their relevance to the target group.

IntroductionA peer support intervention using 'Mentor Mothers' was implemented for mothers who had migrated to Sweden, living in socially disadvantaged communities. The Mentor Mothers had a high degree of freedom to develop strategies for facilitating empowerment of their clients according to perceived needs. This study aimed to investigate which empowerment facilitation strategies that Mentor Mothers perceived to be relevant, feasible and effective.MethodsPhotovoice was used to generate qualitative data. Participants took photographs of their work which were then discussed during a focus group discussion and six individual semi-structured interviews. Data were analysed using thematic analysis.ResultsFour overarching strategies to facilitate empowerment were identified, corresponding to distinctive perceived needs in the target group: (1) Informative support responded to a need for making sense of the external context, by helping mothers navigate society, the process of parenthood and cultural parenting norms. (2) Practical support addressed a need for managing challenges in daily life, by facilitating contacts with welfare services and authorities and to enhance parenting practices. (3) Psychosocial support addressed a need for improved mental wellbeing, by instilling feelings of safety and security in daily life, relationships and in contacts with public institutions. (4) Motivational support responded to a need for finding fulfilling purpose, by promoting social interaction, encouraging civic engagement and sharing the challenges and successes of others to inspire hope.ConclusionsThese results highlight various aspects of peer support for empowerment facilitation that future interventions targeting immigrant parents can use in their intervention design.

Introduction: A South African social innovation based on peer support for mothers was contextualized in southern Sweden. The objective of the project was to support expectant women and mothers of young children in immigrant communities to access public services that would benefit maternal and child health. This study aimed to assess how the intervention was implemented, what the contextual barriers and facilitators were, and how the implementation was perceived by those who delivered and received it.

Methods: The study used mixed methods with a convergent parallel design and followed the Medical Research Council guidance on process evaluations of complex interventions. Semi-structured interviews (n = 19) were conducted with peer supporters, client mothers, and key stakeholders involved in the intervention. The qualitative data were analyzed using content analysis. Quantitative data on peer supporters' activities were collected during contacts with client mothers and were presented descriptively.

Results: The five peer supporters had 1,294 contacts with client mothers, of which 507 were first-time contacts. The reach was perceived as wide, and the dose of the intervention was tailored to individual needs. Barriers to implementation included community mistrust of social services, norms on gender roles and parenting, and funding challenges. The implementation was facilitated by the organization's reputation, network, experience, and third-sector affiliation. Peer supporters tended to prioritize linking clients to other services over the educational components of the intervention, sometimes doing more than what was originally planned. Implementation strategies used included building trust, using multiple outreach venues, using internal support structures, and providing practical assistance as an entry point to comprehensive psychosocial support. The personal connection between peer supporters and clients was highly valued, and the building of relationships enabled them to address sensitive topics. Peer supporters sometimes experienced a blurred line between professional and personal roles.

Conclusions: Peer supporters used a variety of strategies to navigate identified barriers and facilitators. Trust was central both as a contextual factor and a strategy for implementation. It is valuable to maintain a balance between flexibility and adherence to the function of peer supporters. Further research is needed to evaluate the effects of the intervention.

Introduction and aim Social and health disparities persist in Sweden despite a high quality and universally accessible welfare system. One way of bridging social gaps is through social innovations targeting the most vulnerable groups. The South African Philani model, a social innovation for peer support aimed at pregnant women and mothers of young children, was adapted to the local context in southern Sweden. This study aimed to document and analyze the process of adapting the Philani model to the Swedish context. Methods Eight semi-structured interviews and three workshops were held with eleven stakeholders and peer supporters in the implementing organization and its steering committee. The data were analyzed using thematic analysis. Results The analysis resulted in five main themes and fifteen sub-themes representing different aspects of how the peer support model was contextualized. The main themes described rationalizations for focusing on social determinants rather than health behaviors, using indirect mechanisms and social ripple effects to achieve change, focusing on referring clients to established public and civil society services, responding to a heterogeneous sociocultural context by recruiting peer supporters with diverse competencies, and having a high degree of flexibility in how contact was made with clients and how their needs were met. Conclusion The South African Philani model was contextualized to support socially disadvantaged mothers and expectant mothers among migrant communities in Sweden. In the process, adaptations of the intervention's overall focus, working methods, and recruitment and outreach strategies were motivated by the existing range of services, the composition of the target group and the conditions of the delivering organization. This study highlights various considerations that arise when a social innovation developed in a low- or middle-income context is implemented in a high-income context.

AIMS: Children's health is affected by the environment in which they live and grow. Within Sweden's urban areas, several city districts can be classified as socio-economically disadvantaged. This article describes the creation of a child health index to visualise disparities within and between Sweden's three major cities, and how these relate to indicators of demography and socio-economic status.

METHODS: Data were collected for seven child health indicators and seven socio-economic and demographic indicators from the Swedish Pregnancy Register, Child Health Services and Statistics Sweden. An index was created from the health indicators using principal component analysis, generating weights for each indicator. Correlations between index outcomes and socio-economic and demographic indicators were analysed using linear regression.

RESULTS: The largest variance in index values could be seen in Stockholm followed by Malmö, and the poorest mean index outcome was seen in Malmö followed by Gothenburg. The largest intra-urban percentage range in health indicators could be seen for tobacco exposure at 0-4 weeks (0.8-33.9%, standard deviation (SD)=8.8%) and, for the socio-economic and demographic indicators, foreign background (19.9-88.5%, SD=19.8%). In the multivariate analysis, index outcomes correlated most strongly with foreign background (R²=0.364, p=0.001).

CONCLUSIONS: Children's health follows a social gradient and a pattern of ethnic segregation in Swedish cities, where it can be visualised using an index of child health. The resulting map highlights the geographical distribution of these disparities, and displays in which city districts child health interventions may be most needed.

BackgroundDisparities in health persist even in high-income countries, and healthcare systems do not reach disadvantaged families as needed. A number of home-visiting interventions in high-income countries offering peer support for parents have been implemented to bridge the gaps in health in a cost-effective way. The lack of standard for intervention design has however resulted in a large variety of the strategies used. The objective for this article is to conduct a review of peer support home visiting interventions for parents and children in high-income countries, aiming to assess the strategies used, their outcomes and the challenges faced by peer supporters.MethodsRelevant articles published in English between January 2004 and August 2019 were identified using PubMed, and reference lists were reviewed to identify additional articles. Studies were included if they reported on individual peer support health interventions, delivered at home to socioeconomically disadvantaged parents in high-income countries. Nineteen studies were found that met the inclusion criteria, and data were extracted on study characteristics, intervention design and outcomes. Data on intervention design was characterized iteratively to generate overarching categories of strategies used in the programs.ResultsMost studies used healthcare facilities for recruitment, even when the interventions were not delivered by the formal healthcare system. The strategies used to engage supported parents included (1) connection in the form of emotional support, relationship building and matching for background, (2) flexibility in regards to content, intensity, location and mode of contact, and (3) linking through referrals and facilitation of other contacts. A number of significant quantifiable improvements could be demonstrated. Due to large heterogeneity of outcomes, meta-analyses were not viable. Peer supporters experienced challenges with involving other family members than the supported parent as well as with finding their role in relation to other support structures.ConclusionsPeer support delivered as home visiting interventions have been used for hard-to-reach parents in a variety of high-income contexts and for a multitude of health concerns. Overall, despite variation in intervention design, the strategies employed followed common themes and were generally well received.