7-minute read

What is the issue?

People who are labelled as ‘hard-to-reach’ require community and health services just like everyone else. Yet, access to services is difficult, and it is even harder for them to engage in the necessary decision-making process. This group of ‘hard-to-reach’ people is ordinarily, but not limited to, individuals with disabilities, people of ethnic minority backgrounds, the elderly, and people with multiple vulnerabilities such as mental health issues, substance use or facing homelessness. This has meant that their voices are almost completely ignored, resulting in services not being tailored or adapted to their needs. 

In addition to 'traditional' under-represented groups, the digital divide has meant the situation has worsened. Despite most organisations successfully changing engagement to function digitally throughout the pandemic, 1.5 million UK households do not have access to the internet, according to a report by the BBC. This has presented even fewer opportunities for those people and communities who find it hardest to get involved, leading to even larger gaps growing.

Engaging these groups in health promotion is especially important when trying to reach out to individuals who will benefit the most and eliminate healthcare disparities.

Why does this problem exist?

The term ‘hard-to-reach’ is used often to describe people and communities from certain marginalised demographic groups that are either insufficiently or not-at-all represented in services. This framing, however, suggests that the issue lies with individuals choosing not to use a service, overlooking the service itself as being hard to access.

There are many reasons why some groups are less likely to connect with some services and systems than others. Some of these include:

• A lack of trust in systems that regularly turn people away or impose strict eligibility criteria.

• The stigma and discrimination faced when using services, which in turn is shared as a cautionary tale within their own communities.

• A lack of knowledge or cultural awareness about the people and communities a service or system is trying to engage with.

• A lack of access, including seemingly ‘open access’ policies that fail to account for the multitude of other barriers to a service.

• A distrust of researchers—concerns over where the information provided is going, or because information is given, yet there is no follow up.

• Insufficient resources, whether it’s a lack of time, treasure, or talent. All factors are needed in order to facilitate the process from research to knowledge mobilisation.

Responsibility for service providers to engage with everyone

Simply speaking, it's our job to make it as easy as possible for people to connect with us. We might say that our programmes are open to all, but have we tested this notion from multiple different service user perspectives? Typically, the most absent or excluded from our services are the people who could most benefit from support, and equally, on whom we could have the most positive impact.

Services may combat inequalities by directly listening to individuals who have poorer health outcomes, learning and understanding the life context of their target group and identifying potential impediments to improve overall health outcomes.

According to research conducted by Imperial College:

Strategies to better engage communities

1. Work alongside existing natural community leaders

Focus your attention on finding and connecting with the natural community leaders and influencers, as their opinion will always carry more weight. They can lend their trust to you. Remember not to go in as the expert–you are a visitor to their community. Each community has knowledge and skills of their own that you can learn from. Putting lived experience and peer support[1] at the centre of engagement strategies can have a significant positive impact due to the trust and ongoing connection they're able to leverage, build, and sustain. Using this approach, community members are much more likely to respond to your outreach.

2. Talk to people to build trust with communities and individuals

We don’t have to have every answer. Yet, if we genuinely want to work with people, we can talk to people and, more importantly, listen to what they have to say. By having conversations in the wider community, we can find opportunities that align with what matters to them. One of the most effective ways to get people interested is by pulling together a deeply committed and energised group of people. When a group goes out and engages people with passion, it remains an incredibly effective method to get engagement, as people want to be involved in just about anything!

A great practical model to use would be through trained peer researchers[2] who can ask the right questions and use their existing trusted relationships within communities to bridge these conversations. This is something that you can bring to those existing natural leaders as further skills and/or opportunities to use their skills in a meaningful way to benefit the wider community.

3. Get involved in local events

Many communities organise local events that involve local businesses. This can be a great place to start to get to know the community. It raises awareness of you and provides a face for your organisation. You can share your resources and communications with people you meet and give them something to remember you by. This is another place where you can work with your community leaders or peer researchers to find out about these events. You can also gain ideas for the most effective engagement materials to give people.

4. Be a true partner and collaborator of particular communities

One of the keys to engaging local communities is to understand the issues that affect them the most. The community has to see you as a partner that is deeply invested in supporting them for the long-term, with their specific concerns in mind. You can use your own platform to help amplify the voice and needs of a community. It is even better if you step back and let the voice of lived experience stand on the platform themselves.
Be consistent and involved—it is hugely important that you don't 'drop' or forget to reconnect with people and communities you spent so much time building trust. Ongoing transparency is key.

5. Ensure the intervention fits

Co-producing and co-designing[3] services are some of the greatest ways to foster better engagement in services. Built on the principle that the people being helped by a service are best placed to help design it. We can then ensure that our services are built to provide the right type of support, at the right times. Additionally, a community-built service will achieve the impact on people’s lives that is actually most valuable to them.
Getting individuals from your targeted communities involved in designing and evaluating services makes it much more likely that the people who you want to use your services, might participate in services long enough to benefit from them.

What else to think about?

Expect to gather insight and feedback in many ways. There is no one-size-fits-all approach.

Listening directly to your target audience and using a mixed-methods design (i.e., both quantitative and qualitative methodologies), you will be able to gather a better holistic image of people’s lives including their expectations of support and/or care.

Ensure any new work undertaken is not a repeat or duplicate of previous outreach or research. This is not just a waste of time and resources, it also further exacerbates the feelings of frustration. When communities do give up their time to talk and must repeat themselves time and time again, the usual response is ‘why bother if they didn’t listen the first time?’. It is also a reason why a community will pull further away and choose to no longer engage.

According to The King’s Fund [4]:

Helpful questions to get you started

We have devised key questions we believe are essential for planning an effective engagement strategy:

1. How do we understand ‘communities’ across the area? What defines a certain ‘community’?

2. How do we understand communities of interest? For example, faith communities and communities with protected characteristics? Who are the emerging communities in the area? Who are we specifically trying to engage and why?

3. How well do we know our target community, voluntary sector, and emerging mutual aid groups across the area/location?

4. Who holds key relationships with community groups or leaders? Where can these relationships be leveraged, and where can they not?

5. What makes a local leader? What do we know about local leaders? Who are they, and what is their sphere of influence?

6. What existing mechanisms do we have for sharing knowledge and understanding? How can they be enhanced to ensure better efficiency?

How to better engage with excluded communities?

Habitus Collective has extensive experience in peer research and connecting with those underrepresented in healthcare. We have developed engagement tools that will allow you to move from planning mode to knowledge mobilisation. These tools and methods can support you to better engage with all different types of communities.

You can find our webinar “Can’t Engage, Won’t Engage” in our resource hub here, where three leaders across health and community development showcase examples and approaches of great engagement in practice.

Habitus specialises in providing practical, engaging and lasting solutions for mental health.

Find out more about what we do by clicking the button below.

[1] Peer support is when people use their own experiences to help each other. There are different types of peer support—each aim to:
1) bring people together with shared experiences to support one another;
2) provide a space where you feel accepted and understood;
3) treat everyone's experiences as being equally important;
4) involve both giving and receiving support.

[2] Peer research is a research method in which people with personal experiences of the issues being studied, take part in directing and conducting the research. It aims to empower people to affect positive change by participating in research on their own communities. Peer researchers (also referred to as ‘community researchers’) use their lived experience and understanding of a social or geographical community to help generate information about their peers for research purposes.
They may be involved in assisting with research design, developing research tools, collecting and analysing data, or writing up and disseminating findings. Peer research can also be referred to as ‘user involvement’ or ‘service user’ research when it is conducted together with the users of a specific service to evaluate that service. (The Young Foundation)

[3] Co-production refers to a way of working where service providers and users, work together to reach a collective outcome. The approach is value-driven and it stems from the recognition that if organisations are to deliver successful services, they must understand the needs of their users and engage them closely in the design and delivery of those services. (Involve)

[4] How does the health and care system hear from people and communities? Why do services need to listen? (The King’s Fund)