Table 3 Phase 1: exemplar quotes

Intervention characteristics

They just wanted financial impact: how does it help them or how does it stop people coming into the clinic so much and how does it…? You know, they don’t like people not attending clinic when they’re booked in; they don’t like people not talking to them, not coming into clinic, and they don’t like people having complications or needing to go to A&E and things like that. So if you talk about how it impacts on those key outcomes, then they’re interested.C1011

I think just the process itself is just, you know, it gives people a chance to do something that they’ve probably never done. I think to plot someone’s social network map and have that visual of those relationships of the people and the places that are important to them. I think I'd certainly never done that for myself and I think doing that is a nice process for people to be able to do and to see. And to just have that, especially for, we’ve done it with people who are lonely and socially isolated, and to have that time just to be listened to and to speak about your networks and I find that people have really enjoyed the process.C1005

You know, draw out issues around relationships with grown up children and that sort of thing. So I think it helps draw out and helps better understand some of the social dynamics, which might be going on. Because it allows you to open up those conversations, as to why sort of someone might not see their daughter and grandchildren any more than six…you know, than twice a year, for example. Even though they don’t live very far away, or…and this sort of thing.C1013

Having a resource base, which is up to date more generally, is just a really useful tool. So we found in our work that where teams have resource inventories, they are often out of date or people don't necessarily have the personal relationship with people in the local community groups to really facilitate the warm referrals.KI1003

I think it was the fact that there’s a database attached and it was not always that clear how that was being updated or whose responsibility that would have. So, there was one organisation, and they seemed quite keen initially and then ultimately they said we can't waste, our time is so precious, we can't waste it if the information that people get isn't going to be up to date, then it makes all the rest of it redundant, if you like, you know it's sort of wasting people's time. So, although in theory, it's good, they weren't interested unless there was a guarantee that the end information would be accurate. So, I thought that was quite telling really.C1007

If I give them a list of three things, and go, well, oh, look, here’s three things I’ve printed off for you. They can come back next week, well, none of those were any good. You know, have you got some more? And what you’ve done there, you’ve created a passive dependency. Where if a person’s gone out to find information and it hasn’t worked out, they’re much more likely to go, okay, I’ll ask my grandson to come up with some more.C1013

It was the network mapping, that’s the most eye-opening bit of it, and then the linking people to resources, I think people quite liked just having that as a portfolio of options, they didn’t necessarily take them up, but I think the actual networking, get people to think differently, that’s what opened up stuff more actually.C1008

Outer setting

Although you can particularly make the argument for people with mental health problems because of the wellbeing gains from social interaction, from physical activity, from well, you name it, nature and so on, all of the things that you find within communities I think have a, not a potentially, not everything has a wellbeing gain but potentially has a positive impact on wellbeing.KI1003

So, quite a lot of the time, people are going to community groups with a squillion things on their minds like issues, concerns, troubles and for us, we were finding actually loneliness is a bit of a luxury because I can’t pay my bills, I can’t get my kids to school, I haven’t got any heating, I don’t have any food, also, my mental health’s pretty rubbish.C1003

It all really depends on that person’s sort of level of confidence and where they are, and just how big steps they can begin to make, and how quickly towards making changes. You know, for some people, it’s…you know, for someone who’s sort of really struggling to even get out of the house, or get on a bus and all the rest of it, because they’re so fearful. And, you know, got a quite high level of anxiety and moderate depression and what have you, it’s…you know, they’re not going to suddenly go, oh, swimming group, that sounds excellent, I’m off down the swimming pool tomorrow. You know, we know it just doesn’t happen like that.C1013

It was…I think it was really difficult if you had someone who was very disabled physically and very…had a tiny, tiny social network. And there were people…we did come across people like that who were really isolated, and you had really struggled to find anyone in their social networks except health professionalsC1008

So, a lot of the, I guess, response we got from people that we came into contact with at the mosque was that like people in that community aren’t lonely as such or it’s maybe different or people don’t really admit that they’re lonely. So, I think that was an issue…that might be linked to kind of loneliness and stigma of lonelinessC1001

There were some community organisations that weren’t relevant because they were just supporting people with really, really complex needs and loneliness was essentially a luxury. So, I guess the lesson for us, for me, was GENIE^TMworks in a context… you have to understand the users, I think, and understand the people accessing that context.C1003

Inner setting

I think that was the thing that we found was that some of the bigger organisations have the reach but they don’t necessarily…it doesn’t really align with the job role. But then some of the smaller organisations or charities or…you know, like one of the people that we work with a lot are a local organisation which do like befriending and take people on, in ordinary times, not obviously COVID, they do things like tea parties and that sort of stuff and their ethos is around kind of like being neighbourly and this sort of stuff. I don’t know, like, they had the skills but then the problem with some of these organisations, is that they don’t have the resource because they don’t have money and they’re in this like commissioning cycle but they really bought into it. So, it really does depend on the structure of the organisation as well.C1001

I mean, you know, the uptake of tools such as GENIE^TM, I think is always sort of slightly problematic. I mean, regardless of the tool, whether it’s GENIE^TMor any approach, you know, sometimes it’s just a lack of timing…sorry, not lack of. Luck of timing, so you get in when everyone’s sort of receptive and everything, so yeah. So I think it does depend on the ethos of the organisation and to what extent they understand the importance of the social side of health outcomesC1013

I think what we learnt quite early from them and other organisations similar to them was that actually when we’re having these conversations about identifying participants and then how the study will work, because we sort of run in a pragmatic way, that actually you need the buy-in from the high levels. So in a different organisation, which is the Housing Association, they actually wrote it into people’s objectives for the next three or six months, so that the people working in the study actually had like formalised time to dedicate to the study. But it also had to have, you have to buy-in from all the levels. So maybe depending on the structure of the organisation, high level people need to buy into it, but then also the people who are doing the work on the ground, and their managers.C1001

Getting it out into the organisations, it’s getting the training right, getting that enthusiasm right and finding the right people within organisations to actually deliver it and then we’ve got management buy-in, because that seems to be essential with any implementation thing that everybody agrees to it and supports it, so there’s knowledge about that, so that’s sort of what makes things flyC1008

Characteristics of individuals

Or, you know, if they’ve lived somewhere all their life, you know, talk about local parks that they’ve been to and memories and things, so draw out things from their past rather than…because, I wouldn’t want them, me to leave and them just think, oh gosh, I’ve got no one in my map and I feel lonely and make them feel worse than before you’ve got there. So, yeah, that’s how I would try and divert the conversation when people don’t have many people in their network initially.C1005

But then like, for example, in one of the local church groups, we essentially found somebody who was like a real champion of community engagement and GENIE^TMand that sort of stuff. And so after we had trained her, we then were able to kind of like direct people from different organisations in towards her, if that makes sense. So she had the capacity, she was retired and she had the capacity to do it.C1001

Only in that the champions also seemed to be people who were able to build rapport quite quickly with their clients, and because of that rapport they had an effective way of encouraging the client to then perhaps try out some of the activities that were identified through GENIE^TM.C1004

I think peer facilitators are absolutely fantastic. I don’t think we use them enough. And with the right training, the right supervision and the right support, they are quite often, much more effective than professionals. Professionals tend to slip into telling people what to do, providing solutions to people, is kind of TFA. It’s not a criticism, it’s just, you know…it’s back to this, quite often they are working more in a crisis arena as well.

Process of implementation

So we went through a system where, when we were approaching different organisations or community groups or whatever it was, obviously, like I said, we went through the whole spectrum, that we would attempt in the beginning to organise a meeting with the team plus all of the different…all of the stakeholders within the organisation, so that we could…the questions could be asked about what the facilitation process looks like, what the recruitment process looks like and that everybody has the chance to ask those questions and hear the answers all together.C1001

I think there was definitely more engagement [before the pandemic]. And from my point of view, again I find it easier to remember, I felt I got to know that person a little bit, whereas over the phone I sort of, I don't know them that well or at all and it's harder, because I’ve done follow up calls, I find it harder to recall who they are.C1007

But I think, actually, doing the pre-implementation which is around going in and speaking to the organisations, getting an understanding of the work they do, who they are, who they work with, the referral pathways in and out and really sort of understanding their context and finding what little flex there was in the context and then working with GENIE^TMto flex a bit as well and fit that in, that’s where it was really successful.C1003

So, two or three facilitators come to mind that really embraced GENIE^TM, but they weren’t afraid of it and they weren’t afraid to sort of make it their own, if you know what I mean, and it seemed to really resonate with what they wanted to offer their clients and how they worked.C1004

And I suppose I think coming from very much a community background, I was quite conscious that a lot of it was very academic, you know with a lot of emphasis on the academic side of it and the research side of it. And my feeling was some of those facilitators weren't really interested in that. They just wanted to know: how does it work, what's my role, what do I have to do? And I thought maybe the emphasis should have been more on the practical side of it really and then maybe answering questions, rather than the emphasis being on the academic background and justifying why it was a good tool, really, if that makes sense.C1007

They just wanted financial impact, how does it help them or how does it stop people coming into the clinic so much and how does it…? You know, they don’t like people not attending clinic when they’re booked in, they don’t like people not talking to them, not coming into clinic and they don’t like people having complications or needing to go to A&E and things like that. So if you talk about how it impacts on those key outcomes, then they’re interested.C1011