Lack of understanding of the needs of older LGBT individuals is a global issue and their needs are often ignored by health and social care providers who adopt sexuality-blind approaches within their provision. As a result, public services can find it difficult to push the LGBT equalities agenda forward due to resistance to change and underlying discrimination. The aim of this paper is to discuss these issues.
This report considers how a body of participatory research concerning the needs and experiences of older LGBT people was used to create innovatory dissemination tools, which then engaged communities through public engagement to learn about the needs and experiences of older LGBT citizens. Good research has a “long tail” – (in statistics, “a large number of occurrences far from the ‘head’ or central part of the distribution”). The report considers how a film and a method deck of cards, presented to service providers in several workshops over time, offered opportunities to learn and critically reflect upon an informed practice.
Because of the on-going feedback from our workshops, the authors, in turn, learned the importance of having a champion within a community organisation to take forward the LGBT agenda. A report of one such outreach champion is included here.
Consideration is given to challenges involved in creating impact through research, and how participatory community processes may enhance impact to develop over time.
Fenge, L., Jones, K. and Gibson, C. (2018), "Meaningful dissemination produces the “long tail” that engenders community impact", Qualitative Research Journal, Vol. 18 No. 1, pp. 45-54. https://doi.org/10.1108/QRJ-D-17-00037Download as .RIS
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The aim of this report is to explore the ways in which a body of participatory research concerning the needs and experiences of older LGBT people was used to create innovatory tools to engage communities in learning about the needs and experiences of older LGBT citizens (Fenge et al., 2010; Fenge and Jones, 2012; Jones et al., 2013). This body of research and dissemination activities has spanned a period of over 14 years, and has at its heart a commitment to inclusive co-production and public engagement.
Increased public engagement in research is a key element of how research can create “impact” for social benefit (Higher Education Funding Council, 2016), and this has been increasingly emphasised within UK higher education in recent years (Watermeyer, 2012, 2014). The UK Research Excellence Framework (REF) in 2014 allocated 20 per cent of the total score to research impact (Higher Education Funding Council, 2015). However, it is not an easy task to measure impact due to the time lag before impact becomes apparent (Milat et al., 2015). Good research has a “long tail”, and many researchers grapple with the best ways of capturing “long tail” impact.
Long tail impact involves ways of exploring how public engagement activities can contribute to “the less directly attributable aspects of the research impact”, and narrative accounts offer important insights in these circumstances (Greenhalgh et al., 2016, p. 90). This report uses a narrative account of a community champion involved in the dissemination of research outputs through learning tools used across a variety of community settings. The aim of the community-based learning events was to challenge health and social care practitioners to develop more inclusive approaches to practice with older LGBT citizens.
The needs of older LGBT people are often ignored by health and social care providers who adopt sexuality-blind approaches within their provision (Cronin et al., 2011), resulting in their invisibility within care settings (Manthorpe and Moriarty, 2014; Willis et al., 2014). The growing older LGBT population requires communities, alongside health and social care providers, to develop understanding of the unique needs of this population (Moone et al., 2014). Learning tools which promote public engagement can be used to challenge prejudice and discrimination, and are a central element of developing a culturally competent health and social care workforce.
As researchers engaged in participatory research alongside members of the older LGBT community, we felt a strong commitment to make a difference through the research and its dissemination (Fenge and Jones, 2012; Jones et al., 2013). Our community co-researchers were highly motivated to change the status quo regarding recognition of the needs of older LGBT people, and this included a desire to challenge discrimination and prejudice from health and social care providers (Fannin et al., 2008; Fenge et al., 2009). We, therefore, felt that the research outputs should include innovatory tools which could be used “to change minds, change attitudes, and help to build communities where tolerance and understanding are keys to connectivity in the future” (Fenge et al., 2010, p. 329).
The key outputs include Rufus Stone, a short, fictionalised film developed from the core Biographic Narrative Interpretive Method (Jones, 2001, 2003; Wengraf, 2001) used within the Gay and Pleasant Land? Project and Methods to Diversity deck of cards developed from key themes arising from two major research projects. Both the Gay and Pleasant Land? Project (2006-2012) (funded by Research Councils UK as part of the national New Dynamics of Ageing projects), and the preceding Gay and Grey Project (2003-2006) (funded by the Big Lottery) were central.
Our collaborative approach fits with recent recommendations by the Stern’s (2016) review of the REF in the UK which suggests that impact should be linked to bodies of work and collaborative activity to create outcomes that are “understood from a more nuanced and deeper perspective” (p. 34).
The award-winning short film, Rufus Stone, based entirely on research on older people in terms of isolation and connectivity, rurality and sexuality, was made available free-to-view online early in 2015. As of this publication, more than 24,000 viewers in 150 countries have seen the film on the internet. Compared to the usual channels for disseminating academic work, the film’s impact in sheer numbers and geographic reach is noteworthy. Using arts-led tools to disseminate research insures that more than the few who read an article in an academic journal are exposed to the research. The medium itself opens doors to audiences that otherwise would never come across academic outputs.
The bidding process for the Gay and Pleasant Land? Project took three years; the research a further three; and writing and producing the film another year. Rufus Stone has been seen widely in community and academic settings nationally and internationally since, and it is used by many practitioners and service providers in their trainings, including Alzheimer’s UK nationally. This success demonstrates the impact possible through new methods of dissemination using social media and so forth that are now available to social scientists. Nonetheless, patience and perseverance remain the watchwords for meaningful, in-depth impact. Locating, then nurturing, community partnerships are key to the success of this kind of approach.
This report considers how the dissemination of learning tools built from research contributes to “long tail” of research impact. This is illustrated by reference to one case study, and offers consideration of the approach taken and the challenges encountered when raising the needs of older LGBT people within a wider equalities agenda in one local authority in the south of England. The report on this case study is presented here as a narrative, and without “interruption” or dissection into data chunks for presumed “analysis”. As narrativists, we are committed to “not only what research participants say, but also how they say it – both are equally important to report” (Jones and Fenge, 2017, p. 49).
2. Underpinning research
The underpinning research informing the development of the learning tools involved a series of innovative participatory interventions with older lesbians and gay men (Fenge and Jones, 2012; Jones et al., 2013; Jones and Fenge, 2017). As older LGBT populations are subject to discrimination and are “seldom heard” in research or policy (Heaphy et al., 2004), it was important to adopt methodologies that would engage with their voices to promote inclusive knowledge development. The impact of this work concerns both the use of novel methodologies to engage “seldom heard” voices within the research process, and the development of learning tools which use research findings to change hearts and minds and as a result produce social impact.
The initial underpinning research, known as the Gay and Grey Project, was funded through a Big Lottery Grant, and used a novel, participative approach to explore the experiences and needs of older lesbian and gay people, supporting older volunteers to undertake and disseminate the research. This was a defining focus of the project and the Gay and Grey Project has since been acknowledged as developing an innovative methodology for LGBT research (Equality and Human Rights Commission, 2008). The participatory approach used has been acknowledged as offering the opportunity to inform future directions in social policy that are more person-centred and inclusive providing insights which promote good practice with older LGBT people (Wallcraft and Sweeney, 2011). The Gay and Grey Project was the first in the UK to amass a sizeable sample of older LGBT people (Price, 2009) and its methodology is acknowledged as offering an inclusive approach to sexual orientation research (Equality and Human Rights Commission, 2008).
The Gay & Grey Project (2003-2006) were foundational and provided a springboard to the Gay and Pleasant Land? Project (2006-2010), funded by Research Councils UK as part of the New Dynamics of Ageing Programme. The project explored the biographies of older gay and lesbian adults with experience of living in rural Britain. Building on the themes of identity and “coming out” identified in the earlier Gay and Grey Project, the project aimed to empower older LGBT people through a collaborative multi-method participatory action research design which embraced the principles of a Performative Social Science (Jones, 2016; Fenge et al., 2010; Fenge and Jones, 2012) in its dissemination plan. The emerging recollections, perceptions and storied biographies of older lesbians and gay men and their rural experiences formed the bulk of the data studied and the basis for story and characterisation in the short professionally made film, Rufus Stone.
In collaboration with older LGBT volunteers involved in both projects, further funding was gained to translate the findings into a learning tool. This took the form of Methods to Diversity Deck of cards, which contained key learning activities to support communities and agencies to think about their policies and practice in relation to older LGBT people. To launch the use of Methods to Diversity cards alongside a screening of the film Rufus Stone, we organised “Pathways to Impact: ageing, diversity, connectivity and community”, an ESRC Festival of Social Science event in 2012. Building on this initial community engagement event, we offered a two-day follow-up masterclass and train-the-trainers event “Interfacing with older LGBT citizens and challenging discrimination” (2013). The purpose of this second gathering was to continue to spread the use of the film and Method Deck and collect stories of their use and effect. Participants were asked to elaborate on their experiences with the tools and give us feedback for an impact case study around concerns of older gay and lesbian citizens in their communities. Through these two efforts, the tools were disseminated to a range of more than 150 training managers in health and social care agencies in the UK for use in diversity training.
The social impact created because of these two events has been more recently followed up as part of an evaluation of the original community dissemination events. Funded by the ESRC Festival of Social Science, a “Pathway to Impact Part Deux!” (2015) event was hosted which invited participants from the two previous events to share how they had used the film Rufus Stone and the Methods to Diversity tools within their own settings, the challenges faced and the impact of the learning on organisations and communities. All three events resulted in the collection of a massive amount of data for impact case studies.
3. Facilitating social impact through research
As previously discussed, creating social impact to promote inclusive health and social care practice for older LGBT citizens was a key aim of this body of work. Many older LGBT people have experienced a lifetime of discrimination which has left them fearful about “coming out”. This has resulted in individuals being concerned about discrimination from health and social cares practitioners and agencies, alongside difficulty in accessing culturally responsive services (Stein et al., 2010; Fredriksen-Goldsen et al., 2014).
LGBT equalities work within UK local authorities has tended to be marginalised compared to other areas of equalities practice such as gender, race and disability (Monro and Richardson, 2010). Local authorities can find it difficult to push the LGBT equalities agenda forward due to resistance to change and underlying discrimination (McNulty et al., 2010). Difficulty in moving the LGBT agenda forward may be reinforced by a sexuality-blind approach within health and social practice where older people are treated as asexual (Cronin et al., 2011). Other research suggests that residential and nursing home settings can represent hetero-sexualised environments in which LGBT identities and sexual biographies are ignored (Willis et al., 2014). Older LGBT individuals, therefore, face double invisibility due to their age and their sexuality (Blando, 2001). Similar findings have been found in day centre settings where older LGBT people have been described as invisible (Manthorpe and Moriarty, 2014).
Lack of preparedness and understanding of the needs of older LGBT individuals is a global issue, and studies in the USA describe a lack of training and awareness of older LGBT citizens’ needs in most care service providers (Knochel et al., 2012). Against this backdrop, however, there appears to be interest in receiving cultural competency training to promote understanding of older LGBT needs from many service providers (Knochel et al., 2012). The development of “age competent and gay affirmative practice” should focus on and further develop the strengths and resiliency of older LGBT adults (Crisp et al., 2008, p. 6). This requires opportunities to learn and critically reflect upon practice informed by a research informed knowledge base (Richards et al., 2014). The use of participatory workshops to share and discuss research findings with non-academic users has been used to facilitate social impact from research to create sustainable responses (Priego-Hernandez, 2014). Using film as a part of a learning process has been shown to successfully raise awareness of LGBT issues whilst supporting community engagement (Gichuru et al., 2014). The workshops developed as part of our social impact dissemination strategy demonstrate the importance of having a champion within an organisation to take forward the LGBT agenda (McNulty et al., 2010). The following case study describes how one such champion used the tools within an organisation to facilitate learning about older LGBT citizens needs to promote inclusive practice.
4. Case study
The champions in this case study are Hampshire County’s Strategic Equality and Inclusion Manager, Camilla Gibson and Registered Manager, Paul Hazzard, who attended the ESRC Festival of Social Science masterclass in 2013 and felt “really inspired… the energy that came from the masterclass gave us the courage to follow through with this”. Gibson and Hazzard developed bespoke workshops that built on an independent survey into staff’s attitudes towards sexuality and sexual orientation in their local authority. The response rate to this survey was low (300 completed from a possible 4,000 adult Services staff; the survey was carried out in 2007) and this raised concern for Gibson about lack of responsiveness to inappropriate care and potential homophobic behaviour amongst staff members themselves.
Gibson and Hazzard used the tools from the masterclass to deliver workshops to staff within the local authority which last two and a half hours, focussing on service improvement for older LGBT people within the local community. Examples of training events include: a joint conference for practitioners including police, fire and rescue service (n=90); community learning events open to public which showed Rufus Stone; workshops within the residential care home sector; and workshops for operational managers (n=60) including a showing of Rufus Stone and learning based on the Methods to Diversity. During these sessions, the managers apparently got excited about using the cards within their work setting. They found it a refreshing opportunity to think beyond the confines of budgets to embrace an opportunity to explore creative responses to older LGBT needs and many commented that the workshop had made them recommit to their values. Those attending were asked to go away from the workshop and change one practical thing in their own working environment:
Excerpts from CAMILLA GIBSON’s Presentation and Discussion at the Bournemouth 2015 ESRC Festival of Social Science, “Pathways to Impact Part Deux!”
CAMILLA GIBSON: We wanted them to recognise that you need to think about relationships. We’ve added a relationship part to our assessment documents, not just with brother and sister, but also partners. Our social care practice manual has a section about relationships for LGBT people this section we’ve developed together with people from LGBT communities. Our staff network group that we have is working hard to spread knowledge within the LGBT and the wider community. We’ve got the leader of the council understanding the agenda and pushing the agenda. The chair of the staff network, was a key driver to us seeing the first Hampshire Pride to some extend the masterclass has propelled it on as well.
There’s loads more to do, this is just one of the many things that I try to fit in to my time, and if I’m honest, I’m kind of being pushed to worry about all these other things, but I’m like a dog with a bone. I’m holding on to this because I know! I have seen what can happen when we’ve shown the film and used the cards. One older person at a community event said, after seeing RUFUS STONE, “That’s my story […]. I’ve just got back together with my teenage sweetheart”. Another guy came up and said, “This is miraculous! This is exactly my story!” and he said, “Thank you for this, putting on this event because I thought I was the only gay in all of Winchester!” I replied. “I can re-assure you, you are not the only gay in Winchester”. It is so wonderful when you can see that someone who realise that they are no longer alone with their story. There’s just so much work still to be done in the area.
One of the things that came out when I showed the film, particularly when I showed it to younger diverse team, was that some of my colleagues said that they identified with the story not in terms of LGBT but in terms of black and ethnic perspective. It’s kind of what it feels like we can all see it but no one wants to do anything with the issues as well.
I think the method cards are absolutely amazing and I’ve really been impressed with those and how you can use them with people who have practiced for like 30 years and still get something from them and you got someone who’s just newly qualified and they can both could use the method cards and both can contribute in the same discussion.
There has never been a time I’ve used it (the cards) and people go off and talk about other things. They talk about the cards and that’s why they are so great – some time you give people group work and case studies they often talk about all sorts of other things! Every time I’ve done it, they talk about the cards and this is really positive. I’ve never really experienced this with other materials we have used. What is useful as well is that because of the way they are written, the one around sexuality for example, there is inevitably someone who may think it’s a private matter and someone else who thinks differently but there’s room for both of them to aired and explored and this often sparks a good conversation and discussion and room – for both of those views to be aired and to be explored. They are obviously done in a way where people feel its ok to say what they really think and then you start challenging each other on their views, and the packs leave this quite open for discussion.
There’s one around structural stuff that I like to use, care setting ones as well have been really useful. I guess, I pick the ones that are more emotional in a way, I am really trying to get people to imagine being in someone else’s position for example an older gay person and these various scenarios to make it more personal, particularly working with professionals whom appear to be very comfortable with keeping it professional, which seems a stupid thing to say, but it’s like I’m just trying to make it more emotional and try to get people to view it as if they themselves are going through bereavement for example, and especially issues where you can’t even be at someone’s funeral, can you imagine what happens to someone’s identity and so on. So I’m trying to get them to see the human in it and I think that’s what the cards do well together with the film.
LEE-ANN FENGE: When we designed the cards, we were mindful to try to include creative activities. That’s Kip Jones’ influences here as you can imagine – we were mindful that we wanted there to be a range of different ways of thinking and activities people could engage in, so there are some that are discussion discursive thinking in groups but there are some that may enable people to develop a visual pictorial type of exploration of experience or a short script I think there’s even one where we encouraged people to film their own films. Have any of you that have used these used some of those more creative techniques or have you used it more as a discussion.
CAMILLA GIBSON: Unfortunately, no – I haven’t used it in that way and that’s only because of the practicalities of time and having to shoehorn it in amongst other things, so unfortunately no I haven’t. I would like to but maybe that’s something we could do within for example, within my own team, we could do it there. There I’ve got some flexibility to do it.
LEE-ANN FENGE: So, going back to your use of the cards what have been the types of responses how have you felt those cards have made an impact on the participants?
CAMILLA GIBSON: I think as I said before the fact people completely passionately get involved with the discussions, they stick with a subject and people have also then either immediately after or weeks later or whenever they see me say that was really good because it made me really think about my values again and all that kind of stuff and so that I think is what they do well.
Male Participant: I was very impressed you went out and did some focus work with Residential Nursing Homes, just intrigued what sort of reaction you got from providers was there a general acknowledgement that they already had gay and lesbian communities or residents?
CAMILLA GIBSON: Yes, I would say the homes seem to be more accepting. Whether is that by the nature of it being a residential home, you see more of the whole picture. With the agency I don’t know, with that provider we would have a contract and within that it would explicitly say what values need to be demonstrated, and that’s all very well but it’s just report sitting over here. It is all around that it gets lived breathed and challenged every day and that we have it as part of our contract monitoring, do we ask the right questions?
KIP JONES: Talking about the film, it was interesting to me particularly when you used the films as an introduction to workshops or with the cards. Did you find that was the way that you mostly did it?
CAMILLA GIBSON: Yeah, I did always show the film when we did the one that was up in the Discovery Centre as part of LGBT history month, where it was kind of anybody welcome, that was just a film and then a bit of a discussion and reactions afterwards, so then it was just the film. It was a fabulous evening in terms of where it ended, on a high! The film is emotional and I’ve seen it 20 times and I still get goose bumps, it still gets me because it’s so powerful. We also did a bit of a road trip around main office sites of Hampshire, which is massive geographical area to cover so we went to Basingstoke, Totton and Havant. Mostly I’ve done it as two and a half hour’s workshop, as a bit of a presentations setting the context then seeing the film, break – reactions and then into the cards and asking what are you going to do?
KIP JONES: Thank you, Camilla, your story is amazing! When we set out to see this in action in this wonderful way, it’s really a wonderful success as far as I’m concerned. When we held the Premiere of the film, a member of the audience who had been interviewed for the research came up to me and said, “Thank you! Thank you for making this film about my life!” I had to say to him that actually this isn’t just a story about his life, this was a story about many people’s lives. This is the beauty of it, it was never one person’s story. This is why I think so many people can relate to it: it is about anyone in this situation. That is one reason it has been a really big success. It has a universality to it – that’s real.
The other thing for me was that I worried about how it would be received by younger viewers, being a “historical” drama. I was reassured when it went to the Rhode Island Film Festival competition and the film won the two Youth Jury prizes. We later took it Bournemouth’s Lighthouse for a screening with Space Youth Group, which supports and empowers Dorset’s youth who are or may be Lesbian, Gay, Bisexual, Transgender or anything in between. These teenagers really just got the concept and message of the film right away and really identified with it; that made me really happy that we have managed to be able to relate to people of all ages, not just those that were older. Some people have seen the film said, “Well, that might be what happened in that generation, however, things are different today”. At the same time, people are also saying that they can relate to this even though it was set quite some time ago. Some however question the suicide in the film and assume it is a message only for an older generation. I say to them, “Well, why is there an international programme right now running on teenage suicide prevention called, ‘It gets better’?”
CAMILLA GIBSON: Bearing in mind my job title is Strategic Equality and Inclusion Manager (obviously, my team understand this), but I still had people come up to me and say, “I don’t really get why I need to worry about this”. I mean, you’d think that a manager in an older people’s team would be on board with something like this.
KIP JONES: Truthfully, the fact that you took on this effort with such enthusiasm and energy in the face of such obstacles reinforces our belief in the importance of getting well-developed research out into the community via innovative methods and enlisting really committed community members and service providers like you. In the end, it takes the commitment of people like you to make it happen!
This case study provides but one example of the possibilities of creating impact through public engagement. It highlights how research projects that include in-depth output elements and dissemination plans can contribute to social engagement and “impact” for social benefit (Higher Education Funding Council, 2016). The fact that the research in this report began more than a decade ago attests to the principle that research that is meaningful is never really “finished”, and that dissemination is more than simply a few academic journal articles. In this project, “community”, in the guise of both advisory members and community service providers, were pivotal in providing feedback, momentum and expanding the audiences for our efforts. We were mindful that learning occurs throughout the research and dissemination process and we, therefore, learn from all aspects of the journey (Allen, 2012).
It has been suggested that participatory approaches may enhance the potential impact of research as it “promotes knowledge exchange within and between ‘communities’, universities and other research, policy-making or service delivery institutions” (Banks et al., 2013, p. 263). Our approach demonstrates how participatory research which embeds public engagement at its core can help to demonstrate the “long tail” of impact through “transdisciplinary praxis, that involves collaborators from different backgrounds” (Pain et al., 2015, p. 3). This is particularly important when working with marginalised groups, whose voices may be seldom heard, and changing hearts and minds about them.
Approaches to research which embrace public engagement are not without challenges and within universities public engagement often remains “an ancillary rather than integral component of the research process” (Watermeyer, 2015, p. 344). This means that devoting time to the long tail of impact can be difficult to achieve alongside competing demands of the academy. It is, therefore, important to note that key to the longevity and the reach of these projects was the availability of additional small pots of funding from both the Research Councils and our university to carry out the work necessary to continue efforts of both connectivity and outreach. A small internal grant alone recently provided an administrator for a month’s work to transcribe the material for this paper as well as a massive amount of feedback data received from Rufus Stone audience members over five years (which will form the foundation of a separate article and hopefully, a short film).
Impact is not always a moment in the sun – an explosion of a scientific “breakthrough” on the public scene – then yesterday’s news. Good research has a “long tail” – (in statistics “a large number of occurrences far from the ‘head’ or central part of the distribution”). To achieve this, first, it takes tenacity on the part of the research team, or an ability to be a bit blinkered about its work and willingness to stick to the team’s goals and commitment over the long term. Second, it takes allies, and these are often community members, service providers, and so forth, who are energised by the work and take up the mantle. Finally, to create real impact, it takes resources available to carry out the work – not necessarily of the size or scope of the original research funding, but just as important to success.
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