Optimising Making Every Contact Count (MECC) in the Third and Social Economy (TSE) sector: a sequential mixed methods study

Abstract

Background and aims: Making Every Contact Count (MECC) is a UK-based approach to utilising existing interactions service providers have with service users each day to promote health behaviour change, supported by the evidence base for brief interventions (typically lasting > 30 minutes). Although originally delivered within healthcare settings, recent funding and training roll-out has supported the implementation of MECC across a wide variety of settings including the Third and Social Economy Sector (TSE), which describes all not-forprofit groups and organisations that operate outside of the family or household and independently of the government. However, there is a scarcity of evidence to support the effectiveness, acceptability, or suitability of MECC within TSE settings in terms of whether current training sufficiently addresses the unique assets and challenges within TSE settings. Furthermore, the definition of MECC lacks clarity on the included topics and target behaviours, mechanisms, intensity, and who it is delivered by and to. Thus, this thesis aimed to assess the evidence to support the delivery of MECC within the TSE, explore how MECC is experienced and can be optimised in TSE settings, and conceptualise MECC to identify commonalities and differences between MECC when applied in the TSE compared to healthcare settings.
Methods: A sequential mixed methodology was applied. A systematic review included eight quantitative studies measuring the effectiveness of brief interventions to target health or the social determinants of health within the TSE. An umbrella review included 28 systematic reviews assessing the health and wellbeing effects of volunteering on volunteers. Next, qualitative interviews were conducted with service providers (n = 15) and users (n = 5) within the TSE and data was analysed using reflexive thematic analysis and mapped against current MECC training in a strategic behavioural analysis. Finally, the classic Delphi method was applied to generate a descriptive and operational consensus (> 80% agreement) definition among experts (n = 40) across three and four rounds, respectively.
Findings: There is little evidence to support the effectiveness of brief interventions within the TSE, and no available literature measuring the effectiveness of MECC on the health of service users within the TSE. The available evidence mostly supports the effectiveness of brief interventions within the TSE to target smoking behaviour and supports motivational interviewing to be the most promising mechanism. However, benefits of volunteering on the social, psychological, and physical health of volunteers suggests a potential two-fold benefit of health interventions such as MECC delivered by volunteers. Brief health and wellbeing conversations such as MECC can be acceptable to service providers and users providing they are non-imposing and emphasise supporting individuals to help themselves as opposed 5 to provision of advice. MECC training delivered within the TSE should focus on peer support and delivery and emphasise positive outcomes for service users if conducted appropriately. Across settings, MECC is perceived to be defined not in terms of its duration or target topic, but instead by its person-centred approach and the specific skills and techniques employed.
Conclusions: More evidence is needed across settings to support the claim that MECC is evidence-based relating to service user health and wellbeing. However, when delivered by volunteers MECC could potentially exert a two-fold benefit on the deliverer and recipient, building a rationale for MECC within the TSE. Brief motivational interviewing shows the most promise both for health behaviour change of service users and acceptability to service providers and users. Thus, healthy conversation skills, a specific approach to MECC training, is recommended as the most appropriate approach to MECC delivery within the TSE as an opportunistic and non-specialist adaptation of motivational interviewing.

Date of Award	24 Oct 2024
Original language	English
Awarding Institution	Northumbria University
Supervisor	Katie Haighton (Supervisor), Angela Rodrigues (Supervisor) & Rob Wilson (Supervisor)