TY - JOUR

T1 - Understanding How, Why and for Whom Link Work Interventions Promote Access in Community Healthcare Settings in the United Kingdom

T2 - A Realist Review

AU - Golby, Rebecca

AU - Lobban, Fiona

AU - Laverty, Louise

AU - Velemis, Kyriakos

AU - Aggarwal, Vishal

AU - Elliott, Emma

AU - Berry, Katherine

AU - Morris, Abigail

AU - Harris, Rebecca

AU - Chew Graham, Carolyn

AU - McGowan, Linda

AU - Shiers, David

AU - Caton, Neil

AU - Lodge, Christopher

AU - French, Paul

AU - Griffiths, Robert

AU - Palmier-Claus, Jasper

PY - 2024/12/31

Y1 - 2024/12/31

N2 - Introduction: Inequity in access to healthcare in the United Kingdom can have a profound impact on people's ability to manage their health problems. Link work interventions attempt to overcome the socioeconomic and structural barriers that perpetuate health inequalities. Link workers are typically staff members without professional clinical qualifications who support patients to bridge the gap between services. However, little is currently known about how and why link work interventions might be effective. This realist review attempts to understand the contexts and resultant mechanisms by which link work interventions affect access to community healthcare services.Methods: The authors completed a systematic search of empirical literature in Embase, CINAHL, Medline, PsychInfo and SocIndex, as well as grey literature and CLUSTER searches. Context, mechanism and outcome (CMO) configurations weregenerated iteratively in consultation with an expert panel and grouped into theory areas.Results: Thirty‐one eligible manuscripts were identified, resulting in nine CMO configurations within three theory areas. These pertained to adequate time in time‐pressured systems; the importance of link workers being embedded across multiple systems; and emotional and practical support for link workers.Conclusion: Although link work interventions are increasingly utilised across community healthcare settings, the contexts in which they operate vary considerably, triggering a range of mechanisms. The findings suggest that careful matching of resources to patient need and complexity is important. It affords link workers the time to develop relationships with patients, embed themselves in local communities and referring teams, and develop knowledge of local challenges.Patient or Public Contribution: The team included people with lived experience of mental health conditions and a carer who were involved at all stages of the review.

AB - Introduction: Inequity in access to healthcare in the United Kingdom can have a profound impact on people's ability to manage their health problems. Link work interventions attempt to overcome the socioeconomic and structural barriers that perpetuate health inequalities. Link workers are typically staff members without professional clinical qualifications who support patients to bridge the gap between services. However, little is currently known about how and why link work interventions might be effective. This realist review attempts to understand the contexts and resultant mechanisms by which link work interventions affect access to community healthcare services.Methods: The authors completed a systematic search of empirical literature in Embase, CINAHL, Medline, PsychInfo and SocIndex, as well as grey literature and CLUSTER searches. Context, mechanism and outcome (CMO) configurations weregenerated iteratively in consultation with an expert panel and grouped into theory areas.Results: Thirty‐one eligible manuscripts were identified, resulting in nine CMO configurations within three theory areas. These pertained to adequate time in time‐pressured systems; the importance of link workers being embedded across multiple systems; and emotional and practical support for link workers.Conclusion: Although link work interventions are increasingly utilised across community healthcare settings, the contexts in which they operate vary considerably, triggering a range of mechanisms. The findings suggest that careful matching of resources to patient need and complexity is important. It affords link workers the time to develop relationships with patients, embed themselves in local communities and referring teams, and develop knowledge of local challenges.Patient or Public Contribution: The team included people with lived experience of mental health conditions and a carer who were involved at all stages of the review.

KW - community health

KW - healthcare

KW - inequalities

KW - link worker

U2 - 10.1111/hex.70090

DO - 10.1111/hex.70090

M3 - Review article

VL - 27

SP - 1

EP - 18

JO - Health Expectations

JF - Health Expectations

SN - 1369-6513

IS - 6

M1 - e70090

ER -