Adult social care in rural and coastal areas

A participatory realist evaluation
Carer taking the blood pressure of an elderly patient in his home

Adult social care in rural and coastal areas

A participatory realist evaluation
Title: Adult social care in rural and coastal areas – the issues, emerging evidence and process mapping models
Funded by: NIHR
Funding amount: £888,808.92
Location: Cumbria, Devon, Herefordshire and Worcestershire
Dates: January 2025 – December 2026
PI: Associate Professor Michael Clark
University of Plymouth staff: Professor Richard Byng , Professor Sheena Asthana  
Collaborating staff: Associate Professor Annette Bauer, Dr Julie Morton, Dr Mary O'Malley Dr Rosanne Palmer, Professor Michelle Cornes
Contracting organisation: London School of Economics and Political Science
 
This project focuses on developing the evidence base to support better local and national policymaking for adult social care (ASC) in rural and coastal communities (R&CCs).
Evidence of health inequalities in rural and coastal areas has been mounting, prompting some improvements in the evidence base for health interventions and policies to address them. 
In contrast, evidence for ASC in these locales is underdeveloped and there is little evidence for national and local policymakers, practitioners and communities to organise ASC to support people's belonging and maximise wellbeing.
Living in R&CCs can bring benefits to people, which is why many are drawn to live there, but demographic patterns and the geographic profiles of R&CCs present increasing challenges to delivering ASC in them. Some of the positive aspects of living in these areas, such as rurality, may become barriers to effective delivery when people start to need ASC. Workforce shortages, for example, are more significant in R&CCs than in many urban and inland areas, and national initiatives to address workforce issues in R&CCs have focused on health care.
National data provide insights into the challenges of ASC in R&CCs, but may obscure important details, such as about inequalities and context. More fine-grain understanding of ASC in R&CCs, drawing on local expertise of living with support needs and of planning and delivering care, is required.
 
 
 

Aims

This project aims to address the question:
What are the key issues in the delivery of high-quality adult social care in rural and coastal communities, how does this fit with a local systems view, and what does local and related evidence tell us about potential solutions to help national and local policy making in such communities more generally?
Adult social care with carers and residents painting in a care home

Method

Work package one

Literature review and interviews
We will address the question by a scoping review of literature and interviews with a snowball sample of key national leaders to develop a national (England) overview of the issues of ASC in R&CCs. 

Work package two

Case studies
We will work at three case study sites – Devon, Cumbria, and Herefordshire and Worcestershire – each with their own assemblages of assets and challenges, mapping ASC and key issues in each site and developing in-depth understanding of contexts, systems, challenges and possible solutions. This includes interviews and workshops to bring local expertise to the forefront of understanding contexts. Through case studies, we can explore in detail local issues and those crosscutting the localities. An established framework for understanding the delivery of health and care in rural areas will guide our data collection and analysis, allowing comparison across sites and lessons for R&CCs more widely.

Work package three

Process tracing evaluation
We will undertake a process tracing evaluation (PTE) of a sample of ASC interventions designed to address R&CC challenges in the sites to understand not only whether they work, but also how and why (in context). PTE provides a structure for developing and logically testing hypotheses for why things do or do not work in contexts. 

Work package four

Creating impact
A key area of investigation across all aspects of the study will be the relationships between ASC and addressing equality, diversity and inclusion in ASC in the sites and more widely in R&CCs. Public engagement and plans for knowledge exchange underpin all work packages and help to prepare a pathway to impact, drawn together in this final package.

Centre for Coastal Communities

Finding solutions to the challenges facing coastal communities
The University of Plymouth is one of the few UK Higher Education Institutions with a critical mass of academics with a proven track record of research on coastal communities. The Centre for Coastal Communities brings together researchers looking at coastal economic performance, deprivation, migration, educational underperformance, displaced populations, health and social care, the blue economy (renewable energy, fisheries, aquaculture, tourism, recreation and leisure), plastic pollution and economic, social and environmental policy for coastal communities.
 
Fishing nets