An Evaluation of Healthy Valleys: Community Health Café Programme

Undertaken for Healthy Valleys by the University of the West of Scotland

Tackling food poverty is also a priority for us as well as reducing isolation and loneliness which also fits in with and contributes to the national and local social care priorities.

Healthy Valleys Annual Report

We produce healthy food for the community …we get the community out joining in together, having conversations …they can talk about daily things. People, neighbours, come in and sit down together…people new to the village come in and meet people from the village

Jennifer (Volunteer)

It wouldn’t be a café without the food. It wouldn’t be a community without the chat. And it wouldn’t be what happens without the staff!

Gordon, 26, Beneficiary

Report Author: David Wallace Lecturer in Community Education University of the West of Scotland [email protected]

Report Finalised: September 2019

With thanks to Community Food & Health Scotland Development Funding for the financial support for this evaluation.

Contents

1 Executive Summary 4 2 Introduction and Context 8 3 Literature and Policy 10 4 Methodology 12 5 Methods 15 6 Data Analysis Volunteers Impact 19 Beneficiaries Impact 26 7 Discussion and Conclusions 38 8 Future Challenges 41 References 43 Appendices 46

Executive Summary

An Appreciative Inquiry methodology was adopted to structure an evaluation of the Community Health Café programme. This sits within the Community Food Initiative contribution made by Healthy Valleys to Scottish Government Health and Social Care outcomes. The term beneficiary is used by Healthy Valleys to denote recipients of their services.

Appreciative Inquiry is a recognised methodology in medical and health services literature and has afforded a practical method for engaging beneficiaries in the community café evaluation. The report in summary confirms the following:

1 Heathy eating and access to healthy food is central to the community café ethos and was commended by all of those who took part in this study. Access to nourishment through provision of a healthy lunch evidently had a positive impact on beneficiaries.

2 Economic circumstances, structural inequality and rural deprivation continue to provide a context within which Healthy Valleys programmes are initiated and developed. Community Health Cafes, as part of their community food initiative programme, offer an important strand of practice in providing an accessible health promoting service to local people adversely affected by these social and economic indices.

3 The Community Health Cafes programme relate specifically to a response to local food insecurity, diet and wellbeing. Healthy eating and the wellbeing that develops from a social place to meet and eat is evident in a communitarian response to food insecurity and low incomes.

4 The open, accessible and convivial setting is both an attractive characteristic of the Community Health Cafes as a facility and affords a regular social fixture for beneficiaries. The continuing programme further creates the opportunity to recruit others who live locally but have not as yet used the facilities.

5 A diverse mix of beneficiaries take part in the Community Health Cafes programmes comprising a mix of men, women, children and families. Evaluation participants ranged in age from 25 years old to 90 years old and represent an exemplification of effective targeting of people in high risk groups according to Scottish Index of Multiple Deprivation (SIMD) indices.

6 Staff and volunteers were widely praised by beneficiaries. The terms open, friendly, helpful and sympathetic were all evident as were conceptions of caring, diligent and committed personnel.

7 Staff and volunteers are well managed and organised and have appropriate Royal Environmental Health Institute of Scotland (REHIS) training and certification that forms the core for implementing a service focussing on positive lifestyles, wellbeing and healthy eating.

8 Volunteers are as a collective altruistic, well prepared, highly motivated and committed to offering a high level of health promoting service to the beneficiaries.

9 Some Volunteers have been recipients of Healthy Valleys support programmes having encountered issues themselves of isolation, stress, poor mental health, bereavement and exclusion. For some, volunteering offers a therapeutic outlet, a positive contribution that uses the benefit of their own experience to demonstrate both caring for others and the possibility of positive outcomes.

10 The extended network of local volunteers, part-time staff and local beneficiaries represents a nascent and grassroots community development initiative building wider wellbeing through extending the reach of social capital, positive psychology and wellbeing.

11 Beneficiaries highlighted the following positive characteristics of the cafes which individually and collectively represent a significant impact of the programme

1. Having regular access to a nourishing and healthy meal 2. Building health and wellbeing through a mixture of healthy eating, empathy, fun and changed lives 3. Building self-confidence and motivation - offering the possibility of a positive routine that is something to look forward to 4. Breaking a cycle of isolation by affording the possibility of social contact with others 5. Offering an antidote to poor mental health and issues of low self esteem 6. Providing a convivial place where there is a sense of belonging 7. Contributing to personal journeys from isolation to inclusion 8. Building and being part of a community. 9. Providing the possibility of counselling, advice and information or referral to wider Healthy Valleys service or to the services of other local agencies 10. Providing a safe haven

12 Beneficiaries were universally content with the organisation and function of each of the Community Health Cafes in which they participate. Though this impacted their inclination to suggest significant change or improvement, in discussion the following suggestions were made:

1. Better provision in cafes for pre-fives including, changing facilities, child friendly cups and plates (Carstairs Junction) 2. Providing additional cafes - more of the same but on different days (all locations) 3. Providing an extension to the café programme by offering related workshops on matters like crafts, cookery displays, speakers or advice sessions on relevant topics.(all locations) 4. Recruiting more people, specifically people who are in need (Kirkmuirhill and Carstairs Junction) 5. Improved local advertising (Kirkmuirhill) 6. Offering choice of individual tables over the central eating arrangement 7. Providing background music. (Carstairs Junction)

13 As an extension of the appreciative inquiry process, development planning for the Community Health Cafes is already underway among Healthy Valleys’ staff, including a response to these suggestions. Staff were able to report either the means by which local changes to Community Health Cafes could be made (e.g. beneficiaries are able to suggest background music at Carstairs junction; confirming that a mix in table settings is optional at each cafe); to highlight new proposals (e.g. funding being sought for improved pre-fives resources and a revised additional programme of activities in and around the cafes); and, that an additional community café is being implemented to complement the programmes detailed in this evaluation (in Douglas).

14 There was considerable interest and enthusiasm among participants in this study and a significant manifestation of continuing need. For the future, careful resource considerations are therefore required, in the light of the success of the community café programme, to determine the extent to which funders, staff, volunteers and beneficiaries may be drawn into planning and implementing an enhanced community café programme.

15 This evaluation has provided evidence of the merits of the community café programme. However, it is clear that there are a range of additional and important research needs that emanate from constituent components of the community café process. In particular, further research would be merited on food insecurity, the positive psychology emerging from the social aspects of eating together in a community setting and on the potential that exists for community development by engaging with local people (in the targeted population) to cultivate and utilise their own food resources.

1 Introduction and context

1.1 Established in 2003 Healthy Valleys is the parent organisation that manages and runs the community café’ programme as part of its community food initiative programme. A community led health improvement charity it serves people living in rural South Lanarkshire who experience poor health, financial hardship and social exclusion. Participants in the various Healthy Valleys programmes are collectively represented by the common term ‘beneficiary’. Having a health promotion and community development rationale, Healthy Valleys has four organisational priorities that are closely aligned with National Outcome 5 which states that: Health and Social Care services contribute to reducing health inequalities. The four strategic strands are 1) Promoting healthier lifestyles; 2) Volunteer development; 3) Organisational development and sustainability; and 4) Social enterprise. It is the principles and values that flow from these priorities that follow through to the operation of all projects including community food initiatives and the community café programme.

Tackling food poverty is also a priority for us as well as reducing isolation and loneliness which also fits in with and contributes to the national and local social care priorities.

Healthy Valleys Annual Report

1.2 The community food initiative programme has a number of core strands that include practical cooking courses and a physical activity programme. Healthy Valleys is an approved training centre for the Royal Environmental Health Institute of Scotland (REHIS) and therefore has a strong core of accredited training for local people (volunteers, staff and beneficiaries) offering certificated courses on elementary food hygiene, food skills and cooking skills courses.

1.3 Weekly Community Health Cafes have been established in four locations that operate once a week on a drop- in basis in Kirkmuirhill (EST: 2014); Rigside (EST: 2016); Lanark (EST: 2016); and Carstairs Junction (EST: 2018). Community Health Cafes explicitly offer a warm and convivial environment in which a healthy meal can be obtained at low cost. Beneficiaries may make a donation for the meal based on their ability to pay but do not have to pay anything. In addition a Rural Café (Est: 2015) operates in Lockhart Community Hub

(in which Healthy Valleys is based) and serves the needs of local people who may be referred from agencies as a result of food poverty or financial issues, physical or mental health issues or more complex needs that are often located in a combination of these concerns (Annual Report, 2017/18). This café has specifically been developed as means of alleviating the impact of welfare reforms. Participants in the rural café have access to one- one support from Healthy Valleys staff where required. In addition to a wholesome lunch another is packaged for them to take home for themselves/families. These beneficiaries may also obtain support with travel costs to and from the Community Health Cafe.

1.4 The Community Health Café programme operates under the jurisdiction of a member of Healthy Valleys’ staff who coordinates and strategically plans activities. A team of volunteers are deployed in each location and across locations to support the implementation of each café. The cafés operate in shared premises in the form of community halls. A team of part- time staff and volunteers provide the core of local service delivery. Routinely this entails procuring, preparing and serving food and in setting up and clearing away the equipment in each café setting. Seasonal events like Christmas, St Andrews day or Halloween provide themes for the design of menus and to afford seasonal variations. The main provision is a wholesome lunch in the form of soup, fruit and salads and sandwiches or filled rolls. Occasionally there are offerings of health-conscious baked goods (e.g. fruit loaf) or biscuits.

1.5 The cafés explicitly respond to issues around food poverty, provide a nutritional meal and afford the opportunities for health promotion, learning and training. Equally the cafes provide an opportunity to afford social contact, information and advice giving and sign- posting to support services where required. Once launched the Cafés were advertised by posters, social media, word of mouth, local news and promotional work through networking with established local groups. Healthy Valleys has a well-used social media set up and web site.

2 Literature and policy context

2.1 The context provided for this evaluation is set by prevailing social and economic circumstances in Scotland and in particular in the rural south Lanarkshire area that Healthy Valleys serves. Evidence confirms continuing structural inequality (Scottish Government, 2018) and a related impact on education and employment, well-being and social justice (Eisenstadt, 2016). The era of UK government austerity, welfare reforms and the financial implications of Brexit are widely seen as creating a complex environment that adversely impinges on the poorest in society which are the same communities and populations that are already under stress and that are the priority of Healthy Valleys’ programmes (Hastings et al, 2015; Wallace and Coburn, 2016; Alston, 2018).

2.2 Health and wellbeing priorities provide the health promotion and community development focus for Healthy Valleys’ programmes and are related to national targets and priorities (Scottish Government, 2014, 2016, 2017). Food insecurity, food quality, food poverty, healthy eating and sustainability in food production and supply have become national and international concerns with a growing discourse in policy and practice around key food related topics (Ritchie, no date).

2.3 The Community Health Cafes programme relate specifically to aspects of food insecurity, diet and wellbeing, healthy eating and the community aspects that flow from a social place to meet and eat and from the desire to offer a communitarian response to food insecurity and low incomes (Dunbar, 2016; Ritchie n.d, p.14; Healthy Valleys 2018; Liddle, 2018). Indeed a recent Citizens Advice Scotland Report (Liddle, 2018) provides data that affirms the Healthy Valleys analysis of need Vis:

45% of respondents in their study have worried about running out of food before there was money to buy more

35% of respondents in their study in work couldn’t afford to eat balanced meals

23% of people have had to skip meals, so that their children could eat

21% of people in their survey have gone a whole day without eating because they had no money or food

(Liddle, 2018, p.9)

2.4 Literature on the topic has similarly grown with a number of identifiable themes. Hunger and food insecurity is a major strand of analysis and recurring throughout the literature (Cummins et al, 2010; Dowler et al, 2003; Lambie-Mumford et al, 2014; All Party Inquiry into Hunger, 2014; Douglas et al, 2015; Dawson et al, 2008). The social benefits of eating have formed much smaller areas of research and literature as has food insecurity in association with community development responses (Jones, 2007; Lambie-Mumford, 2012).

2.5 Cafiero et al (2016) have provided a detailed analysis and a guide for estimating prevalence of food insecurity. The following indicator is supportive therefore of Healthy Valleys’ analysis and of their concern to develop targeted Community Health Cafes.

Cafiero et al, 2016

2.6 The characteristics represented by participants in this study suggest that most would identify with and have experienced food insecurity and could therefore be located on the moderate to severe continuum in the above (Fig 1). Further the general policy and research literature base highlighted in this selective review provides a crucial context for the work on Community Health Cafes and helps to contextualise the analysis undertaken in the course of this evaluation. These themes will inform analysis and assist in building an objective appraisal.

3 Research methodology

Appreciative Inquiry

3.1 To obtain data for this evaluation a number of options and methods were available. The evaluation rationale was however shaped by an intent to obtain data that reflected the experiences of beneficiaries involved in the community café programme; that was further complemented by the experiences of staff and volunteers engaged in that programme; and that was broadly consultative.

3.2 The subsequent research evaluation process therefore ruled out positivist or scientific research traditions that may be concerned with gathering numerical data or with testing a hypothesis. In drawing findings into a dynamic process of development and change the evaluation of the Community Health Cafes programme was consequently underpinned by qualitative and constructivist traditions (Cresswell, 2014; Scotland, 2012). In this sense the community café evaluation sits within a body of work in community practice research which is defined by its active principles for engagement in and with a community of participants (Hills and Mullet, 2000; Ibanez-Carrasco et al, 2011; Karnilowicz et al, 2014).

3.3 A number of authors in medical and health fields have adopted an approach to research evaluation which is known as appreciative inquiry. Appreciative inquiry sits well with community practice research traditions that reside in action research and participant appraisal research (Ochocka et al, 2010) and that consequently reflect research traditions in community development (Hollander, 2011) that are central to Healthy Valleys philosophy.

3.4 The methodology can have individual, group and organisational dimensions (Sandars et al, 2016) and can be connected to principles both of experiential learning and organisational learning and development (Senge, 1990: Neville, 2007; Cooperrider, 2017). As a participatory research method, collaborative working is a feature of appreciative inquiry as is the intent to address questions and issues relevant to stakeholders (Cohen et al, 2013). Similar to other participatory research methods, active participation in the appreciative inquiry process is seen as a means toward empowerment (Sandars et al, 2016).

3.5 Though prioritising participative and community based methodological considerations, it is instructive to this evaluation that principles of appreciative inquiry are also located with the study of organisational change (Copperrider, 2017). This may also therefore be of relevance to Healthy Valleys and the community food initiative programme team. Taking its focus on what works in a system, rather than on its deficiencies (Stavros and Torres, 2018; Coghlan, 2019), the appreciative inquiry process has been described as an embodiment of generative insight and generative capacity in the interests of obtaining transformative action. Appreciative inquiry in this way may therefore be defined as:

A form of action research which focusses on building on what is already successful, rather than what is deficient, thus leveraging the generative capacity of transformational action.

(Coghlan, 2019, p.189)

3.6 Coghlan (2019, p.68) alludes to a 4 I’s cycle that characterises appreciative inquiry Vis: Initiate; Inquire; Imagine; and Innovate. Offering an interpretation of these characteristics, Reed et al (2005), in evaluating 10 community projects, used a three-stage process to shape their appreciative inquiry. The first stage involved reflection by beneficiaries on points at which their project had worked for them (what did they get out of it); a second stage drew beneficiaries into dialogue about envisaging an improved future for the project (how might things be improved); and a third stage is largely concerned with working collectively to achieve the vision expressed in the second stage (where do we go from here). It is these three broad stages that will inform this evaluation.

3.7 Assisting in achieving consistency across multiple case study sites (like the differing Community Health Cafes) appreciative enquiry was utilised by Reed and Jones (2005) as a means of structuring analysis using a common approach. Following Clark and Reed, (2006) this method therefore facilitates consistency whilst allowing for nuance in differing sites. The principles of appreciative inquiry thus afford a systematic structure for data gathering and analysis. Indeed, it could be argued further that such methodologies sit well within the mission of the parent project at Healthy Valleys in that continuous improvement is a feature of the agency and in which community development principles inform an engagement with beneficiaries that is explicitly consultative and empowering.

3.8 Perhaps uniquely in this evaluation of Community Health Cafes, appreciative inquiry is contextualised by the planning and implementation process that precedes it thus far and in which review and evaluation is an ongoing feature. Though this evaluation report represents a distinctive phase of the community café initiative, for taking stock and quality assurance, it never-the-less maintains an ongoing cycle of reflection to develop and improve services to the community in the community food initiative programme. This is evidenced in various programme documentation and in wider Healthy Valleys’ interim and annual reports. In effect therefore, this evaluation process is a continuation of appreciative inquiry that is already in place with staff and volunteers and within the wider parent organisation. The results of the Community Health Café evaluation process are explicitly intended therefore to complement these existing systems and processes and to inform a renewed cycle of planning and evaluation with participants.

4 Methods and data gathering

4.1 To facilitate the implementation of the appreciative inquiry process a number of approaches were developed in the interests of gathering data for the evaluation. Regular informal briefings and discussion took place throughout the evaluation period with healthy Valleys’ Staff. In addition, informal observations were made of café operations and field notes were also kept throughout the process.

Example of Field Notes from One Cafe

The ********* café operates from premises that are run by a community body as part of an assets transfer process between the Council and Developer. It sits within a shop front premises within a parade of other shops and services. It is on the main street and a bus stop is right on the door step. On the occasion of two visits on 26 February and 12 March general observation and field notes were kept to record the general operation of the café, its dynamic and ambience. The café operates predominately through the serving of a healthy meal offered at a communal table comprising separate tables grouped together in the centre of the room. Beneficiaries therefore congregate together, sharing chat and salutations before during and after a shared meal comprising soup, a choice of sandwiches or rolls, beverages and fruit cake. On the first visit the researcher predominately operated in the background whilst engaging with the volunteers and Healthy Valleys’ staff. There were two volunteers present and the café organiser from Healthy Valleys. Approx. 8 beneficiaries were present, most were senior citizens. An external mental health support project worker was also in attendance to convey project information. There were some informal introductions to acknowledge the researchers presence and the occasion of the visit was utilised to break the ice and inform those present of the impending evaluation programme (and the concomitant need to involve them individually).. The atmosphere was calm and convivial. Those present were clearly regular attenders and known to each other. There was shared chat across the table and exchanges between individuals and the volunteers/staff. The interactions were informal, friendly and inclusive. The general atmosphere was cooperative, sociable and appreciative. This latter dynamic was equally evident on the occasion of the second visit on 12 March for the purpose of obtaining interviews with beneficiaries. On that date, attending slightly earlier than the café start time, the researcher encountered the line dancing group that operates in the space ahead of the café and therefore exited to await the scheduled start. Returning to the café the researcher passed many of the group as they exited the building (i.e. they did not stay for the café). The line dancing it transpires is run by the hall keeper and she is accompanied by a friend (both from Lesmahagow and who travel together). Both were participants in the café.

Many of the same beneficiaries from the previous visit were also present. Given the need to make an impact and recruit to the data gathering process, the researcher initiated and joined in on conversation, reminded those present of his intentions and was consequently invited to join them at the table. This supported an engagement in the general conversation and chat. The chat was very helpful in providing local context, illustrating the existence of internal social networks and pointed to the history of engagement over time in the community café and in the centre more generally. There was a chatty backdrop to the exchanges with individuals catching up and elaborating on stories being told. There were a few warm jokes with Christopher about his relationship with the ladies and a previous expectation of roses being produced. He and the others joined in with the jocularity. As the volunteers worked in the background to serve refreshments and prepare food two other women came into the building. It transpired that this was their first time and, though new, joined the group round the table. There appeared to be some hesitation about joining the main group. They were greeted by the volunteers and offered a refreshment and the people at the table welcomed them but simultaneously began to suss them out. It transpired in conversation that both were local currently but from out with the area originally. The general conversation also continued across the table with shared reminiscences about school, community activity and horse parades. The researcher observed the demeanour of one of the two who appeared to be striving to stick with the engagement though clearly uncertain. It later transpired (ref to interview notes) that this person has mental health issues and was attending for the first time after considerable contemplation with her support worker with whom she was in attendance. Following these exchanges a number of those present agreed to be interviewed individually (with the exception of the latter two who came in together). Meals were served after which interviews took place in the centre office (to the rear of the shop unit) and continued till the community café was being wound up for the day.

4.2 In addition, this evaluation drew on the participation of fifteen Community Health Café volunteers who took part in group interviews or small focus group exercises. Though set up through the offices of Healthy Valleys, methodology and interview questions were prepared by the researcher at the University of the West of Scotland. In addition, ethics and confidentiality were stressed throughout and written consent obtained. All of the respondents agreed to take part and were notified of their right to withdraw at any point.

4.3 Similarly the researcher-initiated contact with beneficiaries through attendance at each of the Community Health Cafes. In conversation the parameters of the evaluation were explained, requests to discuss and record deliberations agreed, and informed consent obtained. Contact with the beneficiaries to participate in the evaluation took place in individual sessions between the 20th of February and 29th March 2019. Contact work was preceded by preliminary visits by the researcher to each of the cafes to affect initial

16 introductions and conduct provisional observations. Staff and volunteers were already briefed and the preparatory work undertaken.

4.4 As in the above statement regarding volunteers, the sampling process was largely opportunistic yet purposeful (Palinkas et al, 2015) in that the researcher took the lead and affected contact independently of Healthy Valleys’ staff. Though the qualitative aspect of the study explicitly focuses on the experience of those involved in the cafés, objectivity and impartiality was predicated on the random aspect of this sampling in that these represented individual and spontaneous engagements with the researcher and could not therefore have been influenced directly by project staff.

4.5 Though not necessarily representative in scientific research terms, beneficiaries were authentic in responses and evidently consistent with the population of users that are the expected recipients of the Community Health Café programme. Ages of beneficiaries who took part in the evaluation ranged from the youngest who was 25 to the eldest who was 90. Some of the beneficiaries who were involved had participated in the cafes over a number of years, for some the interview took place on the occasion of their first or second visit to the café. N.B. There is an intention in this report to synthesise and generalise responses in the interests of anonymity. However, each of the beneficiaries and volunteers in the evaluation were given a pseudonym against which data can be checked and particular quotes attributed (Ref Appendix 1).

4.6 Thirty-one beneficiaries were involved in the process in the following distribution:

Café/Location No of Beneficiaries

Lanark (St Mary’s) 8

Carstairs Junction 7

Rigside 7

Kirkmuirhill 5

Rural café 4

Total No Of Beneficiaries 31

4.7 Though the characteristics of dialogue, negotiation and informed consent are routine in ethical research projects, they are explicitly set out here to demonstrate a systematic approach to the evaluation as a piece of research and to underscore the intended objectivity of the data gathering process. Everyone invited to contribute did so willingly and were keen to reflect on their experiences and to contribute to the evaluation.

5 What the data tells us – volunteers’ impact

5.1 Healthy Valleys recruit, train and support a significant network of volunteers. The expertise, time and commitment devoted to this task is considerable yet is closely connected in principle to ideals of wellbeing, social justice and community development. Though it is clear that beneficiaries are aware of differing roles played by paid staff and volunteers they tended in response to generalise and use the term staff for all of those involved in the provision of the café service.

5.2 Healthy Valleys’ recruitment and deployment of local people to support local health improving initiatives like the Community Food Initiative Programme is longstanding and suggests a significant commitment to community development activity in the rural South Lanarkshire area. Central to the success of this key pillar of practice is the commitment of local people who put themselves forward to volunteer. This evaluation process and appreciative inquiry drew on the contribution of fifteen of the volunteers.

5.3 In addition to the accessibility of the amenities (buildings) and the services (café), most of the Community Health Café beneficiaries in the evaluation highlighted and commended the warm welcome and friendly staff. The service provided by volunteers in particular was commended throughout. Beneficiaries refer to the volunteers as open, friendly, helpful and sympathetic. They were further described as caring and committed. Staff and volunteers were generally acknowledged as offering an active support role, being both courteous and discrete.

5.4 Volunteers met in small groups for a series of focus group type interviews. A range of questions were used as prompts for discussion to draw them in to the appreciative inquiry. These questions aimed to promote their articulation of what the Community Health Café is, to outline the roles they were engaged in and to offer the advantage of their insight to highlight benefits and indicate possible improvements or future developments.

5.5 There was a general camaraderie amongst the volunteers in each of the Community Health Cafés and a clear sense of mission related to the community food initiative priorities. Volunteers were evidently in a position to articulate the rationale for their services, were consistent in representing Healthy Valleys priorities regarding a response to food insecurity

19 and to provide detail of their individual roles within the organisation in support of this response. There was some clarity about role boundaries and the point at which the limits of their duties with beneficiaries is reached and referral is then made to full-time Healthy Valleys’ staff.

Jennifer

5.6 A few of the volunteers have been recipients of Healthy Valleys support programmes having encountered issues themselves of isolation, stress, poor mental health, bereavement and exclusion. For some, volunteering offers a therapeutic outlet, using the benefit of experience to demonstrate caring for others. The capacity of the Healthy Valleys process to create a cycle of opportunities for engagement, training, learning and volunteering evidently contributes to self-worth and resilience. This in turn serves as a catalyst for engagement and action - making their own contribution - and contributes to a strong Community Health Café ethos as exemplified by the dispositions of the volunteer group as a collective.

5.7 The focus on beneficiaries was caring and respectful in all conversations. There was clear insight into the needs of beneficiaries and from experience a capacity individually, and collectively in some instances, for very deep and personal knowledge of particular beneficiaries. It is clear that over time strong and caring relationships can develop. However, it was clear that where there is a strong working relationships and attachment with beneficiaries for some this may give rise to some dilemmas about the point at which referring on takes place. It is this kind of insight never-the-less that provides for an underpinning of empathy and for alerts if there is a change in pattern of attendance by regular ‘customers’. This is exemplified by the following exchange by two volunteers in the same café:

Jennifer: A lot of the people who come in are elderly…some come for a cup of tea, a sandwich and a blether…

Joseph …you get to know the people who come

Jennifer: it’s the conversations…Joseph: …and a laugh and a joke

Joseph: …there’s one guy who comes who has had a stroke and for him it’s part of his rehabilitation…

…and if someone’s not in for couple of weeks we say I hope that person’s OK? …

Jennifer:…or ask someone they usually sit with if they’ve seen them about…

5.8 Staff and volunteers are well managed and have appropriate REHIS training and certification that forms the core for implementing a service focussing on healthy eating, positive lifestyles, and developing a sense of wellbeing. There were several instances of people talking about the roles they perform that may vary between front of house or kitchen and a representation of the willingness of the group to ‘muck in’ and make sure that a consistent and caring service was on offer. Routinely there are ‘specialist’ roles assigned, with particular people fulfilling duties in terms of food preparation and cooking, serving and clearing.

Fiona: We are actually finding there are some participants that this is there only hot meal..they’ve maybe not had a hot meal all week..and they might not have been out in the community or seen people all week…a lot of them are dealing with their own mental health issues that take many, many forms..some may be happy to talk..others may clamp down or just want a one-one

A month ago a man had come in and just wanted talk to someone, and (names one of the volunteers not present) went and sat with him for the whole session, you know the man just wanted to talk…

5.9 All of the volunteers confirmed the status of beneficiaries as local people in most need and many expressed concern and sympathy for those people who were struggling with health or financial insecurity. There is an interesting generational and intergenerational dynamic to these sentiments with many of the older volunteers professing concerns for the younger generation and in particular for young people who make use of the Community Health Café service. Issues of poor health, mental health, drug use, problems with alcohol and homelessness were all cited in anecdotes about particular Community Health Café ‘customers’.

Fiona: There are a number of younger folk…a few older ones…it gives them something to do…I can understand that because that’s why I come (volunteer)… Deborah: (looking round the group) Just to clarify that younger is early 20’s..(more laughter about age jokes).. Ashley: ..it’s a real mix (general agreement from the others)..more younger people are coming but there is still that older generation.. Sinead:..some people have problems and it’s nice to discuss them ..telling you things in their personal life..and try and cheer them up.. Ashley…you don’t just give them their soup..we have a wee conversation with them..get to know them and ..what’s bothering them and what isn’t bothering them..if you can help.. try and cheer them up.. Fiona: I’m always aware that you could be the only person they speak to that day as well.. (general affirmations from the group)

5.10 Volunteers were therefore able to detail the reason people come to the café and confirmed that for some it is a complex interaction of a range of factors. The need for nourishment and a healthy meal was affirmed as a central reason for attending the cafes. Socialising is also high on the list and was expanded by the use of terms like loneliness, company, support, someone to talk to and (repeated by many of the volunteers) a sense of fun and pleasure. This latter point was affirmed in one group discussion with Deborah stating: -

‘Make them laugh…Fun, it’s not all earnest, the banter is important…cheer them up…’

5.11 Volunteers are well prepared, highly motivated and committed to offering a high level of health promoting service to the beneficiaries. In the Lanark Café the disposition of volunteers to be self-effacing became part of an amusing exchange when in a round table everyone sought to underplay their role. Three of the participants when asked to say something about their roles responded:

Volunteer 1: Server the tables

Volunteer 2: Just muck in (background laughter)

Volunteer 3: Kitchen duties (more background laughter)

The researcher had to prompt further for an elaboration and obtained acknowledgement that between the three there were many years of volunteering experience and expertise. Though

22 light-hearted, each then elaborated on their roles in preparing and serving food and in meeting and greeting beneficiaries.

5.12 Fiona signalled her personal motivation to be involved:

…Talked into it by my daughter (names daughter who was one of the founders of the Community Health Cafe) and her enthusiasm…we have great camaraderie and we have fun in the kitchen and we have fun with the folk that come (yes we do) ..and I’ve kept coming since it started…and I’m involved with other Healthy Valleys projects which I really enjoy

5.13 Aside from the familial link in Fiona’s observation, it is evident that the general sentiment of fun and conviviality expressed here would be shared across the volunteer group. There is a clear diligence in meeting commitments to the beneficiary group but this is tempered by a camaraderie and a sense of satisfaction, enjoyment and good humour.

5.14 For Nikki, Healthy Valleys and its services was also a significant force in her volunteering:

When I was younger I didn’t have nothing so after I had my weans and first started Healthy Valleys…did my training and course work - health and safety and first aid…this was maybe what I was needing to get out the house. Healthy Valleys had a crèche…I could get involved and I’ve been here ever since…

5.15 Steph is a volunteer and activist in her area and her motivation for being a volunteer is in part about recognising the value of the Community Health Café service for those in greatest need and who are isolated from support and company. Her rationale for volunteering was as follows

I’m trying to basically promote this area and if I’m going to do it I’ve got to walk the walk - the training and experience I’ve gained has been phenomenal.

5.16 There was a recognition amongst the volunteers as a collective that beneficiaries make use of the café for a range of personal reasons. In discussion it was evident from volunteers that food insecurity, poverty, isolation and mental health were the main reasons that they observed for people use of the community café. Jennifer, for these reasons, articulates what

23 many referred to by stating that ‘you’ve got to be people person as a volunteer’. However she expanded on this stating:

Some people might be shy…I know I’m basically a shy person…but when I joined Healthy Valleys my confidence got built up…so people may be shy…but when they come they end up chatting…people come in to the café and sit where they want..by themselves if they want or with people they know or with strangers…sometimes it’s with people they only know from seeing in the shops…but when they come they do end up chatting together.

5.17 The process of local people finding out about the Community Health Cafes was discussed with most volunteers highlighting social media and the Healthy Valleys web site as a focal point for those who find out about services and drop in. The wider place of Healthy Valleys’ networks in developing a chain of services and referral networks was outlined by Audrey:

They might volunteer to come themselves and sign their self in or they might come on behalf of a Healthy Valleys referral for support…they may have been picked up in other projects we have going ..and they come along here for support…it’s a good way to integrate them back into the community… getting to talk to people that they may not have known before…but I can guarantee that they’ll all end up coming together and they all meet and when they come back the following week they’re looking for each other…

5.18 The extended network of local volunteers, part-time staff and local beneficiaries represents a nascent and grassroots community development initiative building wider wellbeing through extending the reach of social capital and positive psychology. A number of beneficiaries have undertaken Healthy Valleys’ courses and certification, a number of volunteers were previously participants in Healthy Valleys initiatives and a virtuous circle of opportunity and positive pathways resides in this cross fertilisation. This is evident for example in the discussion that took place regarding the Rural Café:

Catherine: People like the fact that people have been here since the start 2015/16 – familiarity

Connor: They can moan and offload…(Laughter) Catherine: They can access information and advice, though we refer on to the Healthy Valleys Staff Connor: However being here at Lockhart they can directly access the Healthy Valleys support network Catherine: Yes a number of people have taken first aid training and mental health first aid training and are aiming to take food hygiene training Connor: and a number over the years have gone on and volunteered with Healthy Valleys and this has enabled them to move on …

5.19 Developing the appreciative inquiry narrative, volunteers were asked to suggest one thing to include in this report to inform future developments. In summary the suggestions made were as follows:

1. I love it it’s a great thing! 2. The Community Health Café breaks down social isolation 3. Our area is not great for new people, it’s difficult to know where to go even although it’s small and isolated. The Community Health Café provides a vital focal point. 4. School holidays can be a time of difficulty for parents and the Community Health Café should expand to offer a more regular holiday service 5. There was feeling that facilities like Community Health Cafés and foodbanks retain a sense of stigma that inhibits involvement. There was a suggestion therefore that some work be done to counter this stigma. 6. More education on cooking from scratch. 7. That we all get on well and enjoy a laugh amongst ourselves 8. Some of the folk we see them up the street…and some that have met through the café have become friends and that’s really good…(chorus) that’s lovely 9. It would be great to have our own permanent kitchen 10. Transportation from the bus station in Lanark to the Lockhart premises for beneficiaries and volunteers 11. More Community Health Café sessions (5 suggestions)

6 What the data tells us – beneficiaries’ impact

6.1 As part of the appreciative enquiry process beneficiaries took part in conversational interviews that took place at each of the Community Health Cafes. These were exchanges covering 5 or 6 question areas that were designed to elicit something of their experiences and expectations of the Community Health Café. The objective across interviews was to build up a data set of transcripts from which a thematic analysis could be undertaken. The appreciative element of the process is represented by the affirmative nature of the inquiry, by its participative and consultative disposition and by the encouragement of a positive outlook for future developments in the café. There are three key stages to the process.

1 The first stage of the appreciative inquiry process involved reflection by beneficiaries on points at which their project had worked for them (what did they get out of it);

2 The second stage of the appreciative Inquiry process is one in which beneficiaries are drawn into dialogue about envisaging an improved future for the project (how might things be improved);

3 The third stage of appreciative inquiry is largely concerned with working collectively to achieve the vision expressed in the second stage (where do we go from here).

Beneficiaries Responses

6.2 All of the beneficiaries who were interviewed identified the benefits of the food provided, acknowledged the vital support this afforded in the context of food insecurity and saw the provision of food as a significant draw and as the catalyst for wider wellbeing through social engagement. Most of the beneficiaries implicitly acknowledged that the café service and the provision of healthy food provided an important response to people in need.

I love the café, I think it’s brilliant. Lisa (25)

I come because the kids get a healthy meal..they don’t like school lunches but here they get healthy options …and they eat it!

Annette (37)

6. 3 All of those interviewed affirmed that the cafes were accessible and fairly easy to get in and out of. For most people the café is within walking distance of their home. Not including

26 the Rural Café (which has different arrangements for transportation of beneficiaries), a number of beneficiaries (5) drive or are driven to the café. A small number of people attend more than one café. Christopher (who is 74) has experience of attending three of the cafes.

6.4 Whilst affirming the common experiences they all shared, and recognising that other people were enjoying the same benefits as themselves, most recognised there were differences in personal circumstances meaning the experience was different for everyone

Nicola (79) and Christopher (74) have only stared coming…they each live on their own and are kind of isolated where they live…I don’t think Christopher sees anyone else other than the folk at the café..(smiling) we have fun with him…he’s easily embarrassed given some of the things we talk about..but he likes us (chuckles)…

Lesley, 70

6.5 Relating to the same scenario, Alanna (40), who was attending the café on that day for the first time, had been drawn into conversation (including Nicola, Christopher and Lesley) over lunch and was therefore already in a position when being interviewed to recognise that some beneficiaries are isolated at home and clearly benefit from the company afforded by the café. Indeed, Christopher, in his interview reinforced the encouragement he had received from Healthy Valleys’ staff to get involved, declaring that it had stopped him just sitting in the house. He went further stating:

…everybody is sociable …from the first day they make you feel at home.

6.6 Recognising that some people with young children come to the café one beneficiary highlighted that the café provides the opportunity for some parents to have adult company. However a prior problem that had affected children’s involvement at Kirkmuirhill was alluded to and has apparently resulted in parents and children no longer attending that cafe. The dispute was rooted in a misunderstanding by one of the older beneficiaries at the time, who assumed the café was for senior citizens and not for children and this has since been clarified. The impact however is that parents with children appear still not to be attending.

6.7 A number of beneficiaries made it clear that they still suffer from low confidence or mental health issues. Making the first steps in to the café was not always therefore straight

27 forward and required a significant degree of resolve and, for some, a residual and pervasive sense remained that they were taking a bit of a risk by coming in.

It all depends on different circumstances…when I first came to the café I lacked confidence and was very nervous…

Mellisa, 43

6.8 Demonstrating the need for the provision of services over the longer term it became evident that for, most beneficiaries, over time this trepidation appears to dissipate. This trepidation is replaced for many with a growing and deep sense of belonging that resides in the relationships that build up by regular attendance.

A lot of us are on our own, you go home and you’re back to being on your own..that’s the path I’m on right now..but here you get a good chat, a nice time..you can just sit and relax and it’s a nice atmosphere…its just so nice.

Emma (46)

6.9 The ability to obtain a healthy and hot meal was also universally acknowledged as a positive. For some the implication of attending the café was that they would be having their only hot meal of the week. For others the nutritious meal had become a focus for changed life styles and attempts to improve diet and healthy eating. Most alluded to the healthy eating and health promoting ethos of the project.

6.10 There was a recurring undercurrent in chat that in the context of a healthy eating initiative may have appeared somewhat ironic. In representation to the researcher a number of people talked light-heartedly about the need for more salt! The interesting thing here is that most appeared to be well versed with the reason for a low sodium menu and therefore evidently had taken on board the healthy eating message – even although new habits may be in formation and were still a little resisted.

6.11 The reaction from Amy in the undernoted interview excerpt exemplifies the open and receptive nature of the cafés. The process she describes also signals that simply opening the doors may not be sufficient and that individuals may still be reticent about joining in. She clearly identifies with a stressor which served as a trigger to initiate her first encounter with

28 the café – it should also be noted that her reticence about participation was despite the involvement of friends already in the café group.

Question: Why do you come, what do you get out of it? Believe it or not this only my second time at the café…I’m a bit of a recluse I don’t get out much but a couple of my pals have been coming,,, they had been trying to talk me into coming for a good few weeks..I thought nah nah its not my thing,, and then I was having (arch) ‘a bit of a day at home’…my kids were annoying me and stuff and I needed to get out for 5 minutes and ..I just walked in here and they made me feel at home..

… You just get to be yourself. I don’t need to put airs and graces on in here…though we’re all from all different walks of life…

…I spoke to (names member of staff) the last time about council issues she could maybe help me out with and stuff like that.. it’s got an atmosphere about it that made me relax……so if all it achieves for me is getting me out of the house once a week that’s fine by me…

Amy 43

6.12 Here again, though Kirsty has come along to participate in the café and acknowledges the vital support provided by the availability of healthy food, she struggles at first to identify positive reasoning for her participation.

Question: Why do you come, what do you get out of it? Kirsty: Em..(hesitation)..I don’t actually know…I don’t actually know how to answer that to be honest..em..(long pause)… Researcher: ..well what would you be doing if you weren’t here? Kirsty: If I wasn’t here I‘d be lying on the couch sleeping… Researcher: ..so instead you get out of the house… Kirsty: …yes I get out of the house and get to interact with adults (smiles) and not just kids (laughs)…even like.. he’ll say (indicating her pre 5 son) ‘are we going to the café?’...he knows that it’s on a Monday and we’ll be here.. Researcher : ..are there other things he goes to? Kirsty: No. Nothing actually! It’s really great for both of us to get out of the house…and for him to interact with other children…and adults. Kirsty,40

6.13 Paul also warmly acknowledged the provision of a varied and healthy menu but appeared to take that as a given, focussing on what flows from the food service at the café in his response:

Question: Why do you come, what do you get out of it? Paul: Just the talk and all that..and it gets you out of the house for an hour or two at least…. Researcher: (in response to an interruption and background clamour of young children playing near the interview table) ..are any of these yours? Paul: Naw naw… mine’s are at school…at high school! I like the craic here ..its good banter..aye and it helps to meet other folk from the community... Paul 50

6.14 It appears to be the case that the food preparation and service in the cafes affords a stable and well received core of the café programme. The provision of nourishing food seems to exist as a fixture around which wider benefits accrue. For example when asked to give consideration of what they get from involvement in the Community Health Cafes, the majority of beneficiaries mentioned two further features that flow from the provision of food and meeting nutritional needs; 1) the motivation to get out of the house; and 2) the opportunity for socialising and meeting people. Around this initial draw however are a range of other important characteristics for healthy living and wellbeing that are identified by beneficiaries and that are consistent with Healthy Valleys wider priorities as exemplified by the following exchanges:

Researcher: What do you get out of it? Why do you come?

Gordon: Socialising, instead of sitting in the house by myself glued to a tv set, you’re coming out having a chat..and a laugh with your neighbours..you might not see them for days or weeks but catch up and have a laugh here..and see if there’s anything to be done (referring to helping each other out).

6.15 In addition to the community solidarity aspect of the café Gordon also highlighted the importance of the fun aspect of participation:

Researcher: What do you think others get from coming? Why do they come?

If it’s not fun your just coming for the food..and that’s not enough..it what else you get out of it…

He then elaborated:

Gordon: …I know some of them are quite isolated, I know some of them don’t go out much so they’re coming to socialise and talk to people they don’t normally talk to..and to meet new people really.

Gordon 26

6.16 Though acknowledging the central role in the process played by the provision of nourishing food, Gordon, Nicole and Annette typified response by emphasising how this facilitates a wider engagement that affected socialisation, motivation and wellbeing.

Researcher: What do you think other get from coming? Why do they come?

Nicole: I don’t know! …Sometimes it’s like..I need to go I’m starving…then everybody’s got things going on..and then sometimes you need to speak about it..

I’ve recently started counselling at Healthy Valleys…at the café they really are good, they’ll sit with you and have a laugh with you.. it’s really good. It’s all different people and there’s more coming every week….nobody really gets together much these days..then when we all come together at the café it’s great for chatting and catching up with gossip and sharing stories ..having a laugh…I think it’s great.

Nicole 45

Community Health Cafes – providing the motivation and opportunity to get out of the house

I live alone and my eyesight is bad so I decided to start coming to the café last month..I can walk there…it makes you to get dressed, get your coat on and take a wee walk…and then meeting up with people…to talk with other folk.

Denise (77)

6.17 The emphasis given to this factor was often heartfelt and emphatic. In the absence of the Community Health Café a routine of introverted or isolated lives was portrayed. To a number of the beneficiaries their capacity to get out of the house appears limited. These limitations are located in a number of factors which include caring responsibilities, chronic and other illness, disability, mental health issues, lack of confidence, lack of resilience and poverty. Evidently for some a combination of these characteristics may prevail. For many, the context of their home lives and state of mind was provided by a general lack of local facilities and/or a general lack of opportunity in terms of social stimulation. There appeared to be limited opportunities in the community for recreation or for learning.

6.18 It was common for attendance at the Community Health Café in this context to be contrasted with a likelihood of being cooped up at home or spending time in sedentary pursuits like watching daytime TV or sleeping on the couch.

Lisa (25)

I’d turned myself into quite an anxious person after a bad period in my life..I took a lot of drugs…but I come to this café and it gets me out and talking to people ..it helps my anxiety so much once I’m here, I feel myself calming down…I feel my shoulders relaxing…I come by myself and it’s easier than I thought to join in..They’re all brilliant and ask how you are, give you a hug..its really good they want to know how you are and you want to know how they are…aye.. aye and try to make you feel better.

6.19 Lisa alluded to the camaraderie that exists between her and some other café users and between her and volunteers. Indeed in the volunteer interviews it was clear that a deep

32 concern and affinity exists for people like Lisa which demonstrates a desire to sustain productive engagement and a shared empathy about her past life which is known (to staff and volunteers) to have been chaotic, isolating and frightening.

Community Health Cafés – combating isolation and realising benefits of socialising and meeting other people

6.20 In addition to the process of sitting down together to eat, the opportunity of attending the café was always connected to the benefits of socialising and meeting other people. Chat, banter and craic were all terms used in this context suggesting a dynamic and engaging process which is fulfilling, enriching and fun. One beneficiary with a new baby noted that the café was relaxing for her and her partner who also attends.

6.21 Several people alluded to the fact that the opportunities for people to meet together and socialise are limited. The changing pattern of employment and economic activity in the area was cited in several instances as breaking down community ties. The corollary of this was the number of people in the study who rate the café highly as a place to belong to and to meet others in their community. There was often an affectionate and enthusiastic emphasis given in responses underscoring the benefits accruing to beneficiaries from the socialisation process afforded by the café as a meeting place.

I think the café is brilliant, you get to have a laugh and a giggle…you make memories with people…

Annette (37)

6.22 In networking terms a high percentage of respondents who alluded to the socialising process knew people in the café but also talked about the importance of meeting new people.

I hear what’s going on the village..catch up on the gossip and the stories..it’s a chance to catch up with other people..

Kerena (83)

6.23 This maintenance of social interaction and development of new networks appeared to be an significant success factor and was afforded high importance by most beneficiaries. These ideals for socialising are particularly interesting in the light of the evaluation in that the

33 ability to join in and access the service is not always straight forward as a result of self- doubt, low self-esteem and lack of confidence. A number of beneficiaries reflected on a process of initial trepidation or worry about fitting in when first attending the café. The provision of food provides a core attraction, offers a motivation to attend and affords the capacity to blend in and to join in with others in the community.

6.24 An interesting counterpoint made by two beneficiaries in contrast to this however, was that they felt some people bring their problems with them whereas they would prefer the café to be a haven away from such problems which is why they come.

Community Health Cafés - Looking to the Future

6.25 In the spirit of appreciative inquiry beneficiaries were invited to highlight an area for improvement or change. This reflects principles espoused by a range of authors (Cooperrider, 2017: Neville, 2008; Sharp et al, 2017) and aims to pave the way for considerations of what and how change may be affected. As part of a developmental conversation the topics of change and improvement necessarily followed on from earlier question areas that were designed to initiate dialogue and draw on a reflection of individual and collective experience. The intention also was to have established rapport between the researcher and beneficiaries and to build a foundation for projecting change or improvements.

Researcher If you had a wish and there was one thing about the community café you could improve or one thing you could change what would it be?

Kirsty: (Pauses) Em..I don’t know…if they could maybe make it twice a week…or maybe a wee play area for the kids…and (with some vocal emphasis) some facilities to change children’s nappies…also they don’t have kids cups or plates…you know those unspillable cups…

It doesn’t really need to change though…the food is lovely .. (more emphatic) the food IS lovely!..

Kirsty 40

6.26 In terms of appreciative inquiry having this dialogue about change might appear straight-forward but didn’t always meet with what might be expected as a response. It

34 appears to be the case that for beneficiaries there is a high regard for the café, for the staff and for Healthy Valleys. The four recurring and overlapping elements of satisfaction were

• Food and in particular the availability of good food for those in need • Staff and the positive and affirmative disposition that they collectively engender • Socialisation and chat and an opportunity to commune with neighbours and friends, old and new • The stability, routine and reassurance of knowing the Community Health Café was operational on a given day

6.27 When invited to prioritise from these characteristics the predominant reaction was to suggest that they could not be separated. This may most effectively be summed up by Gordon’s reaction:

..it wouldn’t be café without the food. It wouldn’t be a community without the chat. And it wouldn’t be as good as it is if the staff weren’t here.

Gordon, 26 This provides for a powerful commendation of the Community Health Café as a trusted, safe and welcoming place

6.28 Though these profound sentiments affirm the success of the programme in meeting Healthy Valleys’ and funder priorities it also results in an element of deference. The first reaction from at least 50% of beneficiaries when invited to consider change or improvement was a pause, or an exclamation that they didn’t know what could be improved or that nothing needs to be changed. For some this was indeed their final position in that, after some further thought, they concluded that indeed the café works well as it is and did not require any change. Some on pondering the possibility of improvement and in conversation posed the possibility of some tweaking of the model to arrive at some new content and different variety of activities.

6.29 This exemplifies a level of brand loyalty and a sense of identity as café users. Many appeared, at least in the first instance, to be proprietorial about the service in the cafes as provided. The research and evaluation process may be flawed therefore in that there was insufficient time within the context of interviews that took place in the café to fully facilitate

35 reflection or to develop the conversation and draw out beneficiaries. At the very least this response is possibly limited and may suggest the need for further action research to fully develop the appreciative inquiry cycle so that beneficiaries may be further involved in defining and implementing change (or otherwise).

6.30 This is not to say that the third phase of the appreciative inquiry process was not productive. The overview provided by beneficiary contributions complement an insider and informed perspective for the researcher (as someone familiar with Healthy Valleys programmes and as an experienced community development practitioner). That the model as set up works effectively is evidenced in the rich narratives encountered in the appreciative inquiry process. Volunteers, paid staff and beneficiaries are evidently part of a systematic service implementation in which there is demonstrable fulfilment of programme objectives relative to health and wellbeing with a target population. A continuation of the café model in this current iteration is logical and will continue to satisfy strategic objectives of Healthy Valleys, NHS, South Lanarkshire Council and Scottish Government. Many of the changes suggested by beneficiaries would simply embellish an already successful model. The following broad ideas were identified:

a. Better provision in cafes for pre-fives including, changing facilities, child friendly cups and plates (Carstairs Junction) b. Providing additional cafes - more of the same but on different days (all locations) c. Providing an extension to the café programme by offering related workshops on matters like crafts, cookery displays, ,speakers or advice sessions on relevant topics.(all locations) d. Recruiting more people, specifically people who are in need (Kirkmuirhill and Carstairs Junction) e. Improved local advertising (Kirkmuirhill) f. Offering choice of individual tables over the central eating arrangement g. Providing background music. (Carstairs Junction)

6.31 As an extension of the appreciative inquiry process, development planning for the Community Health Cafés is already underway among Healthy Valleys’ staff, including a response to many of these suggestions. Staff were able to report either the means by which local changes to Community Health Café could be made (e.g. beneficiaries are able to

36 suggest background music at Carstairs junction; confirming that a mix in table settings is optional at each cafe); to highlight new proposals (e.g. funding being sought for improved pre-fives resources) and a revised additional programme of activities in and around the cafes); and, that an additional Community Health Café is being implemented to complement the programmes detailed in this evaluation (in Douglas).

7 Discussion and Conclusions

7.1 As a research evaluation undertaken under the imprimatur of Healthy Valleys, the researcher from the University of the West of Scotland recognises the ‘insider position (Hodkinson, 2005) this embodies and of the consequent privileges that this entails. Though largely a stranger in the context of each café, the welcome was warm and open. The trust embodied in the interview process exemplified the trust and respect evidently held for Healthy Valleys and the staff and volunteers. This hugely advantaged the data collection process.

7.2 Those beneficiaries who took part in the appreciative enquiry did so willingly and were often immensely candid in their appraisal of their personal experience and how this is contextualised by their engagement in the Community Health Café. Though this cannot be generalised across all beneficiaries it is indicative of effective engagement strategies that such a range of characteristics were evidenced. For illustration the researcher was appraised of matters relating to drug and alcohol histories, chronic physical health issues, mental health issues, bereavement, poverty and severe social isolation. These issues were routinely connected with, and offered in contrast to, the positive experiences that grow from having a social routine afforded by the provision of the Community Health Café. This experience was often portrayed as a dynamic and sophisticated process in which a journey was conveyed from social isolation to some social engagement; from social anxiety to a sense of belonging through involvement in the café; from an absence of routine outwith the home, to a regular commitment to attend; or from a feeling of missing out to a feeling of being involved. In terms of healthy eating, a number of respondents alluded to growing awareness of the benefits of a healthy diet and to the motivation for healthier eating that had not existed prior to involvement in the Community Health Café. Some conveyed a sense of either not having sufficiently nutritious meals, not being able to afford healthy produce or indeed not always being able to afford food. There were a number of representations made that confirm that for some the café affords a singular opportunity each week for hot food and social contact.

7.3 Across the different cafes a common characteristic is that the combination of staffing, healthy food and social engagement provided a convivial environment - a positive boost to confidence and wellbeing. Relationships with staff (especially the volunteers) was subject to considerable praise and often cited in the context of a sense of care that may be missing in other aspects of the beneficiaries’ life. The sophistication of this process is also exemplified by ready identification by beneficiaries of the cafe staff as trusted sources of chat, guidance, support and information. Many alluded to information available via the café and to other

38 activities provided by Healthy Valleys in which they currently or previously participated. It was evident that for those who chose to do so, there are social support outlets, activity sessions, personal development opportunities and a sense of community that emanate from participation in the weekly cafés. Staff were commended for their goodwill, for their empathy and for the provision of a range of healthy comforting food.

7.4 As an overview the café environments were all seen as accessible, open and friendly. All of the beneficiaries who took part in the interviews spoke of the ease of engagement. For many this was contrasted or contextualised with prior or continuing low self-esteem, low confidence and social anxiety expressed in a variety of ways. A number alluded to previous or current mental health issues. The café was represented often therefore as an antidote to these adverse characteristics and as providing a form of social balm affording human contact, emotional support and social inclusion that for many of these respondents may be in short supply.

The settings and function of the Community Health Cafés

7.5 The Community Health Cafés each have a common DNA, characteristics of which are recognisable regardless of setting. The common elements relate predominately to the core organisational function from Healthy Valleys and to central principles and values. A unique selling point (USP) observable from this core is the role played by staff and volunteers. There is an identifiable commitment to the beneficiaries, a commendable sense of duty yet a conviviality that lends both approachability and mutual respect. There is a feeling expressed by regular beneficiaries of a sense of routine, something that is dependable and people who are always there for them. This contributes to a general sense of belonging and wellbeing. One respondent likened this to the Cheers television programme conveying a sense of belonging and a theme song which features the lyric where everyone knows your name.

7.6 The organisation behind the scenes appears to work effectively. Though not examined in detail for this evaluation the provisioning or shopping for food, preparation and serving of food, set up of spaces with tables and chairs and the necessary coordination of staff and volunteers all worked smoothly with no evident conflicts, omissions or failings. There is a routine in practice in which the programme runs according to a schedule. Hygiene and health and safety requirements operate as routine with evident care to maintain a clean and safe operating environment. This starts with the planning of each week’s menus, flows through into the rota

39 of staff and volunteers, to the arrival and preparation of food and to the set up and preparation of the café space. Staff and volunteers monitor attendance and keep a register with contact details. Beneficiaries arrive, sometimes en-masse, sometimes spread out across a session. Sometimes there is a quiet spot, sometimes there is a rush.

7.7 Orders are taken for food in the form of hearty soup and light salads, sandwiches and rolls. These are then served up to the beneficiaries at their tables. Though people can sit on their own if they choose, a sociable atmosphere is observable. Rigside and Lanark café tends to be organised around individual tables set out café style. Kirkmuirhill and Carstairs Junction have also used this set-up but have largely moved to adopt a setting in which tables are grouped together into one communal eating area. As the venue empties the clear-up continues with a bustle of activity by staff to wash up, fold up tables, stack chairs, general cleaning up and otherwise attend to leaving the borrowed space as it was found.

7.8 This is systematic success that speaks volumes for the organisation of the programme. It also speaks volumes for the success in creating an environment where staff and volunteers collaborate effectively to implement café services. Like successful community projects elsewhere much of this organisational effort is seamless and behind the scenes and would not be obvious to beneficiaries or to the casual observer.

7.9 Healthy Valleys is a registered centre for providing training and issuing food hygiene accreditation to all of the café volunteers. This training and accreditation appears to solidify both the organisational development of the programme and the consistency of the healthy eating message that is conveyed to beneficiaries. There is also a level of consistency in operational values that is central to the effective operations of the Community Health Café. The infrastructure and effort required of an organisation to develop this capacity over the medium to longer term with a significant volunteer pool is exceptional. It is evident never-the- less that this pays dividends in terms of beneficiary satisfaction, stimulating wellbeing and contributing to wider community development.

7.10 Beneficiaries and volunteers contributed the benefits of their local experience and suggested a number of possible changes/improvements that if risk assessed may be readily adopted. More strategically the following changes or improvement were suggested that will call for an increase in resources and staffing

1. Developing cafes to run on other days 2. Developing an extension to the existing service in which additional cafes operated in conjunction with activities like arts and crafts, workshops and cookery demonstrations 3. A general increase in resources and staffing

7.11 In community development terms there may be scope to appraise or reappraise community profiling in each area to identify with segmented target groups e.g. senior citizens, parents and young children, people with disabilities and black and ethnic minority groups. This might be most appropriate in areas like Kirkmuirhill, Carstairs Junction and Rigside with a view to augmenting the current cohort of café users. If this community profiling confirms it, and if sustainable levels of resources can be found, the existing café programme may be adjusted to offer pop-up, taster or pilot sessions specifically aimed at particular groups. This would also offer a device to renew and reinvigorate existing clientele in particular settings like Kirkmuirhill at which there are apparently very few Kirkmuirhill residents in attendance.

7.12 Lest it be assumed that the Community Health Cafe is simply a worthy project in which earnest endeavour is exemplified, a central characteristic evidenced in observation and in feedback from beneficiaries is the element of informality, sociability and fun. In recording interviews, and the conversations they entailed, there was often banter, humour and chatty exchanges. The recording its self was often contextualised by background chatter and laughter. Though there are clearly serious issues about structural inequality and poor wellbeing these are dealt with sensitively by staff and volunteers amidst a generally open, convivial and welcoming service provision.

8 Future Challenges

8.1 There is clear evidence of impact on beneficiaries in the Community Health Cafes programme. The provision of a community café service in which participants are able to obtain an affordable and nutritious meal is systematic, accessible, appropriately targeted and affords a wide range of benefits that collectively represent a sound health promotion and community development programme. The existence of food poverty was evidenced and the likelihood of continuing or increasing need in the medium to longer term confirmed. Though there are issues of sustainability that emerge in terms of the longer term funding of this programme, it

41 is clear that the Community Health Café are highly regarded and afford an excellent developmental opportunity. Evidence in this evaluation confirms that those involved expressed a high level of satisfaction and would welcome a continuation of the programme up to and beyond initial funding to 2020.

References

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Appendices Appendix 1

Pseudonym, age and home area of beneficiaries taking part in the Appreciative Inquiry

Carstairs Junction Name Age Home Area Kirsty 40 Carnwath Paul 50 Carstairs Junction Nicole 45 Carstairs Junction Amy 43 Carstairs Junction Siobhan 58 Carstairs Junction Gordon 26 Carstairs Junction Kirkmuirhill Nicola 79 Lesmahagow Lesley 70 Lesmahagow Danielle 46 Carluke Alanna 40 Kirkmuirhill Kimberley 66 Lesmahagow Christopher 74 Rigside Lanark (St Mary’s) Rebecca 32 Lanark Catherine 61 Lanark Steven 58 Lanark Laura 64 Lanark AnneMarie 53 Lanark Mellisa 43 Lanark Lisa 25 Lanark Teresa 52 Lanark Rigside Amber 32 Rigside Kerryn 31 Rigside Ryan 40 Rigside Denise 77 Rigside Kerena 83 Rigside Annette 37 Rigside Eddie 90 Rigside Lanark (Rural Café) Fiona 54 Lanark Jane 29 Lanark Margaret 32 Carnwath Jane 46 Biggar

Appendix 2 Sample of Field Notes from One Community Café

The ********* café operates from church hall premises that are run by the church and a community body. It sits within a historic church campus and is easily accessible from the main road close to other shops and services. It is on a main thoroughfare in the town close to parking, rail and bus services. The facilities are modern and welcoming.

On the occasion of two visits on 20 February and 20 March general observation were made and field notes were kept to record the general operation of the café, its dynamic and ambience.

The café operates predominately through the serving of a healthy meal offered at tables for six or eight set out in rows in the church hall which serves as a general civic or community facility. Beneficiaries are distributed in small groups around the room, there is a chatty dynamic with conversation at and across some tables. Volunteers move in and out of the room engaging with beneficiaries and initiating and receiving salutations and conversations. The clamour builds as orders are taken and food (Soup, Sandwiches/Rolls and fruit or biscuits) is served to each of the tables.

On the first visit the researcher predominately operated in the background whilst engaging with the volunteers and Healthy Valleys Staff. There were six volunteers present. The café organiser from Healthy Valleys was also present. Approximately 20 beneficiaries were present, ages ranged from senior citizen to early twenties. An external project worker was also in attendance to convey project information (on community mental health services) and to raise awareness of her project. This was obtained naturalistically, through conversation and appeared complementary to the routine service provision.

There were some informal introductions to acknowledge the researchers presence. The atmosphere was calm, organised and convivial. Those present were clearly regular attenders and known to each other. There was shared chat across some tables and exchanges between individuals and the volunteers/staff. The interactions were evidently informal, friendly and inclusive. The general atmosphere was cooperative, sociable and appreciative.

This latter dynamic was equally evident on the occasion of the second visit on 20 March for the purpose of obtaining interviews with beneficiaries.

Many of the same beneficiaries from the previous visit were present. Given the need to make an impact and recruit to the data gathering process, the researcher mingled by moving around the tables, initiated conversation to inform those present of his intentions and generally sought to explain his presence. Some people were consequently engaged by the researcher at the table as they sat, some were interviewed at a separate table for privacy and several beneficiarys and volunteers had conversations in between. Staff and volunteers affected introductions and assisted in offering first names in response to the researcher so that individuals could be approached for interview in a friendly manner.

The general chat with volunteers (who had been interviewed at an earlier stage of the process) was convivial and helpful in breaking the ice and setting up interviews. Some familial information was provided by beneficiaries and one beneficiary gave an extended riff on local history and family networks.

As the volunteers worked in the background to serve refreshments and prepare food, beneficiaries began to assemble and take up places at the tables. A small group arrived having participated earlier that morning in the Healthy Valleys arts and crafts workshop and this appears to be a routine for that group. There were warm greetings and hugs for one individual who had come to the café but had missed the arts and craft group.