Co-producing change: community involvement in research and action to address low birth-weight in an East London borough Susanna Rance [1], Angela Harden [1], Gail Findlay [1], Patrick Tobi [1], Dilisha Patel [2], Gulnar Ali [1] Asmat Syed [1], Jin Tong [1], Judith Stephenson [2] [1] Institute for Health and Human Development, University of East London [2] Institute for Women’s Health, University College London Faculty of Public Health EXPO & Annual Conference 2017 – Telford, 20th -21st June

Low birth-weight: an issue of local concern In 2014-16, 9.7% of babies born to women living in the London borough of Newham had low birth-weight (<2.5 kg). Nearly four in ten women living in the borough (37.4%) were at risk of having low birth-weight babies. Preventing low birth-weight and its adverse consequences is a priority for Newham’s Clinical Commissioning Group. The locally-funded project “Low Birth-Weight in Newham: Definitions, Antecedents and Consequences” aims to: understand factors influencing low birth-weight identify community assets that could help to address the issues involve stakeholders in co-producing preventive action.

Using elements of the CEAD model for community and stakeholder engagement in co-production of a local programme Findlay G, Tobi P (2017). Well Communities. Perspectives in Public Health; 137(1):17-20

Low Birth-Weight project stages and stakeholder involvement ENGAGEMENT Community consultation PPI group RESEARCH Hospital data analysis Community asset mapping Interviews with parents & professionals ACTION Stakeholder consultations & feedback Prioritisation Workshop Intervention co-design Pilot actions & evaluation Patient and Public Involvement group Stakeholder prioritisation workshop

Results of the co-design process Appreciative Enquiry workshops, with discussion and voting on priority proposals, brought initially divergent stakeholder positions closer together: Common interests 1-to-1 and group support for parents Women’s pre-pregnancy care Healthy infant feeding Shared concerns Professionals’ conflicting messages Involving partners and family members Addressing language barriers

Co-designed Action 1: Piloting and evaluation of pre-pregnancy service delivered by “health buddies” in primary care Women planning a pregnancy, recruited via their GP practice, are offered “Healthy Conversations” with trained volunteer health buddies. Tinati T, Lawrence W et al. Implementation of new Healthy Conversation Skills to support lifestyle changes – what helps and what hinders? Experiences of Sure Start Children’s Centre staff. Heath & Social Care in the Community 2012; 20(4):430–437

Co-designed Action 2: Case studies and video for public dissemination showcasing local healthy infant feeding initiatives Antenatal, postnatal and community-based drop-in breastfeeding support sessions; and community baby & toddler group

Current step: co-designing an improvement model Empowering relationships and Healthy Conversations Dissemination of evidence-based “missing messages” Partnership working and reflective practice Evaluation of pre-pregnancy “health buddy” service delivered in two local GP practices UEL Knowledge Exchange Internship: “Partnership work translating research into action: taking key messages from the Low Birth-Weight in Newham study into healthy infant feeding initiatives”

Topics in tension: challenges identified in the co-design process Expectations of “health buddies” Involving women’s partners Gaps in breastfeeding support Not/talking about formula feeding Avoiding rapid “catch-up” growth of babies born small