Informing adoption of a social model of health and wellbeing: A systematic review of literature

Hywel Dda University Health Board (UHB) have identified a strategic ambition to work towards a social model of health and wellbeing. In doing so, the health board have recognised the need to ensure that the overarching approach and ambition is working towards a defined and recognised model underpinned by academic rigour.

To achieve this, a strand of work by Aberystwyth University has been commissioned to conduct a systematic review of the academic literature, designed to identify, and inform future strategic development. Aberystwyth University have a long tradition of research expertise in social and physical sciences, rural policy, and economics. More recently the university have developed an increased health focus through the development of their Centre for Excellence in Rural Health Research and increased taught provision of a variety of allied health and nursing programmes. The academic team for this programme of research comprise expertise from the Departments of Psychology, Computer Science and the School of Business and Management in recognition of the diverse body of research likely to comprise the literature in question. The team therefore contribute knowledge of a variety of methodological approaches and offer insights to organisational change and community development to guide informed recommendations.

The review seeks to address the research questions:
•How has previous literature conceptualised or defined 'a social model of health and wellbeing’?
•How has previous literature implemented, or evaluated the implementation of a social model of health and wellbeing?
•What global evidence of best practice exists around the implementation and evaluation of a social model of health and wellbeing?

Through a systematic process to search and review the literature, 222 eligible papers were identified for inclusion in the final review and data synthesis. Data was extracted to explore the country of origin of papers, the methodological approach taken, and the health and social care contexts within which they were set. The papers were then coded using NVivo software and later themed into commonly occurring topics in relation to the research questions.

In summary, papers were predominantly from America, the UK, Australia, Canada and wider Europe. The majority were narrative reviews with a smaller number of empirical research studies comprising qualitative, quantitative and mixed methods set in a wider range of health and social care settings. Five overarching themes were identified: 1) the lack of a clear definition of a social model of health and wellbeing; 2) the need to understand context; 3) the need for cultural change; 4) integration and collaboration towards a holistic and person centred approach; 5) measuring and evaluating a social model of health.

Key conclusions of the review centre on the need for organisations such as Hywel Dda UHB to decide how a social model will be defined within the organisation, how this dovetails with the current biomedical model, and whether the model will act as a descriptive framework or will require further development to become a measurable operational model. The review highlights the importance of engagement and collaboration with end users and multidisciplinary health and social care staff to ensure that transition towards a new model is done with holistic needs of end users and organisational staff as a central value. Finally, the review highlights the challenges associated with the lack of a clear linear pathway to transitioning to a new model of care, emphasising the complex and unstandardised approaches to the implementation and evaluation of a social model that are likely to be necessary and in potential contrast to the current biomedical approach.