Inequity in access to healthcare in the United Kingdom can have a profound impact on people's ability to manage their health problems. Link work interventions attempt to overcome the socioeconomic and structural barriers that perpetuate health inequalities. Link workers are typically staff members without professional clinical qualifications who support patients to bridge the gap between services. However, little is currently known about how and why link work interventions might be effective. This realist review attempts to understand the contexts and resultant mechanisms by which link work interventions affect access to community healthcare services.
The authors completed a systematic search of empirical literature in Embase, CINAHL, Medline, PsychInfo and SocIndex, as well as grey literature and CLUSTER searches. Context, mechanism and outcome (CMO) configurations were generated iteratively in consultation with an expert panel and grouped into theory areas.
Thirty-one eligible manuscripts were identified, resulting in nine CMO configurations within three theory areas. These pertained to adequate time in time-pressured systems; the importance of link workers being embedded across multiple systems; and emotional and practical support for link workers.
Although link work interventions are increasingly utilised across community healthcare settings, the contexts in which they operate vary considerably, triggering a range of mechanisms. The findings suggest that careful matching of resources to patient need and complexity is important. It affords link workers the time to develop relationships with patients, embed themselves in local communities and referring teams, and develop knowledge of local challenges.
The team included people with lived experience of mental health conditions and a carer who were involved at all stages of the review.
Carolyn Chew-Graham (Editor-in-Chief), Parisa Aslani, Sarah Derrett, Michelle Flood, Clarissa Giebel, Lisa D. Hawke, Andrea Hilton, Kerry Kuluski, and Georgina Warner (Associate Editors)
We would like to thank all the reviewers from around the world who have provided expert advice to ensure publication of the best quality articles in Health Expectations. Their feedback is crucial to improve the quality of manuscripts and to clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The names of those who reviewed the manuscripts are listed below.
Our warmest gratitude goes to all of them, and especially to our top 10 reviewers.
Marianne Saragosa
Klejda Harasani
Mark Harris
Ashfaq Chauhan
Robin Gauld
Brooke Allemang
Muhammad Muneeb Hassan
Natasha Sheikhan
Susan Rifkin
Nagihan Sim Aygul
People with lived and living experience (PWLLE) and family members (F) can engage in mental health and substance use health research beyond participant roles, as advisors, co-researchers, equal partners and research leads. However, implementing meaningful and effective engagement is complex.
This article profiles five research initiatives involving different lived experience engagement structures, situated in a single tertiary care teaching and research hospital.
The profiled projects feature various study designs and stages, ranging from initial priority setting to implementation efforts. The levels of engagement range from consultation to PWLLE/F leadership. Across diverse populations, all embody high-quality engagement and illustrate that PWLLE/F can have an important impact on a wide range of mental health and substance use health research.
Engagement can be implemented flexibly within a single research institution to meet a wide range of needs and preferences of researchers and PWLLE/F.
Each of the research initiatives profiled was conducted with substantial lived experience engagement, as described herein. People with lived and living experience from each research initiative are also included in the authorship team and contributed to this manuscript.
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