Final Report for British Society of Gerontology Averil Osborn Award for Participatory Research

Dr Holly Gwyther*1, Mrs Sue Crump2, Mrs Lynne Chalk2, Mrs Sue Warr2, Mrs Megan Betteridge2, Mrs Isobel Thompson2.

1 Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4AY

2 Stay and Play Volunteers, Longbridge ExtraCare Retirement Village, Austin Way, Rednal, Birmingham B45 8TD

January 2020

Acknowledgements

We would like to thank the Stay and Play attendees, both adults and children, for their enthusiasm for the Longbridge group and support for this study. We would also like to thank the staff and residents of the Longbridge Village as well as the ExtraCare Charitable Trust management team for their support of this research. Finally, we must thank the people who have willingly and cheerfully given their time and expertise to assist the project, particularly Phil Crump, Graham Chalk, Peter Gould and Juliana Rossi.

Summary

This study describes a short participatory art and photo-elicitation study examining volunteers’ experiences of an intergenerational Stay and Play project located at the Longbridge village of the ExtraCare Charitable Trust, an independent living retirement community in Birmingham, UK. Four resident volunteers and one non-resident volunteer co-produced a photographic exhibition with a researcher from Lancaster University. Three of these resident co-producers took photographs that were meaningful to them. Twenty photographs were selected for the exhibition with the selection process forming the basis of a focus group interview.  Co-producers were further involved in a coding and analysis workshop of focus group data to interpret themes. Three themes were identified: nurturing the Longbridge community, generating social value and social identity, and expressing personal values and identity. Findings demonstrate the co-producers’ active role in widening community participation within the retirement village and reducing age-related segregation; their strong sense of belonging and cohesion generated through the shared success of the project; and the role of professional and personal values in inspiring the Stay and Play volunteers to action, and assisting social mobility for some potentially disadvantaged children. Loneliness and isolation were described only in either historical terms as echoes of early parenting years, or empathetically in reference to parents’ feelings, suggesting that this was not the principal motivating factor for volunteers.

Contents

Introduction. 4

Aims and Objectives. 6

Method and design. 6

Recruitment. 7

Participants. 7

The Setting. 7

Ethical issues. 7

Procedure. 8

Results. 9

Nurturing the Longbridge Community. 9

Generating Social Value and Social Identity. 13

Expressing Personal Values and Identity. 15

Discussion. 18

Limitations. 20

Budget. 20

Introduction

Intergenerational practice (IG) is the practice of bringing people of different generations together, often with the aim of reducing loneliness and social isolation.  Loneliness and social isolation are key concerns in the United Kingdom (UK), as evidenced by the launch of the UK Government’s first loneliness strategy, based on the view that loneliness is a public health risk (Department for Digital Culture Media & Sport 2018). It has been suggested that loneliness increases the risk of premature mortality at a rate approximately in line with smoking or obesity (Holt-Lunstad et al. 2015). It is associated with a greater risk of frailty (Apóstolo et al. 2018, Gwyther et al. 2018), high blood pressure, coronary heart disease and stroke (Valtorta et al. 2016), depressed mood (Iliffe et al. 2007), and cognitive decline and dementia (Cacioppo and Hawkley 2009, Fratiglioni et al. 2000).

Conversely, intergenerational contact and social connectedness have been found to be beneficial for both younger people and older adults alike. A recent review by Gualano et al. (2018) described 27 international IG programmes and reported beneficial effects on older adults including improvements in wellbeing, depression, self-reported health and self-esteem, irrespective of the intergenerational activities chosen or performed.  Children also benefited demonstrating positive changes in their perceptions and attitudes towards older adults, evidenced through changes in their utilisation of language. Hatton-Yeo (2010) also suggests that intergenerational practice has effects on younger people in terms of skill development, friendship and relationship development, and improved confidence and self-esteem.

ExtraCare is an organisation that facilitates independent living for retired older adults in a community environment.  At ExtraCare Longbridge, ‘The Village’ consists of a large, purpose built apartment block designed around a social space that includes a restaurant and café (the “bistro”), gym, hobby rooms, drop-in clinic and shops. Residents live independently within their own apartments but have access to the community facilities. There is also an option for residents to secure additional social care services that make life easier, including personal care and housekeeping. 

While ExtraCare villages create many benefits for their residents, including opportunities to enjoy an active lifestyle, to some extent they also spatially (Kingman 2016) and culturally (Gullette 2004) segregate older adults from their wider community.  Loneliness is common after life transitions such as retirement, bereavement and moving home (Perlman and Peplau 1982) and these transitions are common amongst ExtraCare residents. In addition, social isolation may be one of the principal reasons older adults move into a community living environment (Health Quality Ontario 2008) and although this improves with ExtraCare residency (Holland et al. 2019, Holland et al. 2017), it is still a matter of personal choice to engage in village life (West et al. 2017). 

To counter this, ExtraCare is committed to embedding intergenerational practice and to building an ‘ageless’ community within each of their villages. Such practices include opening up the village facilities to the wider community, and include offering gym memberships for non-residents and a Stay and Play scheme at some villages for pre-school age children. The Stay and Play group offers a weekly drop-in session in the village for pre-school age children, accompanied by their parents or guardians, to socialise and access age-appropriate play and toys, as well as educational activities.  Village residents set up, run, manage and volunteer at these groups and carry out tasks such as registering people, setting out toys, engaging with parents and children, snack time, planning and supervising activities, e.g. arts and crafts, sand and water play, and tidying up. They also plan and create one-off events such as a ‘Teddy bear’s picnic’.

Incorporating intergenerational practice into ExtraCare communities makes sense for older adults in terms of reducing social isolation and enabling wider community engagement. It also provides the opportunity to influence residents’ health and wellbeing through volunteering opportunities, given that volunteering has been shown to positively influence survival rates, as well as components of mental health and wellbeing including depression and life satisfaction (Jenkinson et al. 2013).

However, ‘measuring’ or quantifying the individual benefits from this type of community engagement and understanding the “lived experience” (Finlay 2014, p121) of individuals is challenging, particularly in a short-term study.  One research tradition which may support this effort is that of interpretative phenomenology. Phenomenology is the study of investigating lived experiences and can be used to examine human activities and interactions. The benefit of using a phenomenological approach lies in its ability to examine the individual experience of intergenerational contact in order to determine which aspects are most meaningful to participants. This approach can be supported by a variety of qualitative methods including photo elicitation studies.

Broadly, the aim of photo elicitation (Higgins and Highley 1986) is to use photographs to facilitate discussion, in this context around space, place, people, activities and experiences.  Photo elicitation requires participants to reflect on what is meaningful to them when they make decisions about what to photograph and provides insight into how participants experience the event or phenomenon of interest. Photo elicitation is a novel way of researching intergenerational activities, although it has been used previously in health psychology research (Guillemin and Drew 2010, Wang and Burris 1997) and in the investigation of communities (for a review see Harper 2002). Photo elicitation can be participatory in that it can involve participants in both the data collection and analysis, a process known as auto-driven photo elicitation (Samuels 2004). As such, it is an ideal method to help to understand how residents interpret their own experiences of the intergenerational Stay and Play project. Another benefit of this method is that the photographs taken, and ultimately the experiences of residents, can be shared in an end product, a photographic exhibition.  Thus, photographs can be used as an extension of an interview technique but also in their own right, as artistic works and a powerful visual tool.

Thus, this paper describes a short participatory art and photo elicitation study examining residents’ experiences of an intergenerational Stay and Play project located within the Longbridge Village of the ExtraCare Charitable Trust (ExtraCare).

Aims and Objectives

  1. To determine how co-producers perceive their experience of the intergenerational Stay and Play scheme.
  2. To co-produce a high quality exhibition for display to other ExtraCare residents and staff, health and social care practitioners, and academic audiences, that demonstrates their connection and engagement within the community.
  3. To gain a greater understanding of whether this type of intergenerational scheme can help to address loneliness or social isolation amongst ExtraCare residents.

Method and design

There are seven regular and committed volunteers at the Longbridge Stay and Play project, five of whom are residents. Four of the resident volunteers and one non-resident co-produced the exhibition and research findings with the researcher (HG). Co-production is a democratic approach in which researchers and the public work together to generate knowledge (National Institute for Health Research 2018). Although by necessity much of the research design for this study was conducted before the involvement of the volunteers, the term ‘co-producers’ is used throughout to demonstrate the critical input of the volunteers to this study and its findings.

Recruitment

A flyer was delivered by a member of ExtraCare management to the resident volunteers of the Stay and Play scheme containing a brief synopsis of the study and the researcher’s contact details to determine interest. Once the volunteers had indicated an interest in the study, a meeting was arranged between two resident volunteers and the researcher, where the volunteers were provided with a more detailed information sheet and consent form. These two co-producers recruited the additional volunteers who also provided informed consent. 

Participants

All of the co-producers (and in fact all Stay and Play volunteers) were women. Four were ExtraCare residents while one was a non-resident relative of another volunteer. They chose not to disclose their precise ages but the resident co-producers were aged in their seventies and eighties with the non-resident in their fifties. Three co-producers (two of whom were residents) lived with a spouse or partner, and two resident co-producers lived alone. Sue C and Lynne set up and were the driving force behind the Stay and Play group two years ago with other volunteers joining shortly afterwards. Two of the volunteers (Sue C and Sue W) had significant experience of working with children. Sue C is a trained National Nursery Examination Board (NNEB) nursery nurse with more than fifty years’ experience working with children in various settings including the NHS, while Sue W worked as a classroom teaching assistant for a number of years.

The Setting

The ExtraCare Village forms part of the recent residential and commercial regeneration of the former car manufacturing site and industrial complex in the south west of Birmingham, UK. The Longbridge ward forms part of the Birmingham Northfield constituency which is amongst the 10% most deprived constituencies in England (Bradnam 2015) and 32% of children in the constituency are defined as being in poverty (Birmingham City Council 2015).

The Longbridge ward has a population of approximately 30,000 people. The ExtraCare village is set on five acres close to the regenerated Longbridge Town Centre. The village opened in July 2017 and consists of 260 apartments. The Stay and Play project is held during school term-times only in the village hall, which can be accessed via the main atrium. The project is not advertised except through word-of-mouth and children have to be registered and signed in at each visit. A small charge of £2 is made for each session to cover the cost of activities and snacks.  The group has a steady attendance of about 30 pre-school age children, although more are registered to attend. The capacity is limited to 30 children, to enable sufficient space to play and to meet fire regulations (including volunteers and parent attendees). The overall planning is done weekly by Sue C, apart from Christmas, Easter, Mother’s/Father’s day and other important days in the Calendar year, which are planned in advance. For normal sessions, the co-producers each have designated roles within the Stay and Play group and take responsibilities for certain activities, for example one person is responsible for the craft table, one for the puzzle table, and one for the play dough table.

Ethical issues 

Co-producers were fully informed of the timescales and purpose of the research.  They were given information sheets in plain language and written informed consent was requested and provided. Co-producers were asked whether they would prefer to use pseudonyms to protect their identity, or their own names in the exhibition and any academic papers. They chose to use their own names. Parents or guardians with parental responsibility (referred to hereafter as parents) at the Stay and Play session were provided with written information sheets in plain language about the purposes of the research. An ‘opt-in’ approach was used whereby explicit permission to photograph children was sought. Two parents chose not to participate. Reasons revolved around concerns over the likely distribution of photographs in one instance and a childminder feeling unable to consent to children being photographed on parents’ behalf in another. Explicit consent for the use of exhibition photographs and a photographic release form was obtained from all parents. Children’s names were not used. Parents were made aware that they could withdraw their permission and data/images at any stage up to publication.  Permission was granted by the ExtraCare Charitable Trust to undertake the research on their premises and ethics approval was provided by Lancaster University Research Ethics Committee, #18060. Volunteers and researchers underwent Disclosure and Barring Service (DBS) checks.

Procedure

Co-producers received an information pack including study information, an easy to use digital camera and a manual for reference. They were shown how to operate the camera, and how to delete photographs that they did not wish to be viewed. They were asked to take as many photographs as they liked over two or three Stay and Play sessions, specifically of things that were meaningful to them, or that best represented or reflected their own experiences. No restrictions were placed on the number of photographs, the subjects, or the composition of those photographs.

Three volunteers chose to take photographs, over three consecutive weeks. The timescale was selected to fit with planned activities including the ‘Teddy Bear’s Picnic’ and a natural break over the school summer holidays which enabled the co-producers to schedule the focus group and analysis workshop in the next two consecutive Stay and Play timeslots. In total, 198 images were taken and downloaded onto a password protected laptop and saved securely on University servers by the researcher before the cameras’ memories were erased. The photographs included images of the room before people arrived, children playing and taking part in activities, adults participating in activities, specific activity stations, volunteers, ExtraCare residents and pushchairs. 

Four co-producers attended the photo-elicitation focus group where all of the photographs were displayed on a laptop, viewed and discussed individually. Collectively a decision was made about which photographs should be included in the exhibition. Due to budgetary and space constraints we were restricted to choosing only 20 photographs to be printed on large canvases for the exhibition.  Over the course of two hours, the co-producers chose their most meaningful photographs. These were not necessarily the ‘best’ photographs but rather the photographs that best described the co-producers’ experiences of the Stay and Play project. A semi-structured script (see Appendix 1) was prepared in advance by the researcher for use as an interview prompt but not all questions were asked. 

Focus group interactions were audio-recorded and transcribed verbatim by the academic co-producer (HG).  The transcript was then shared at an analysis workshop attended by five co-producers. Printed exhibition photographs were also available. Co-producers chose titles and discussed captions for the photographs. Two photographs were deselected at this stage as it was felt that they repeated content. Then, with support from the academic co-producer, resident co-producers conducted an initial coding and search for themes in the focus group interactions. Thematic analysis (Braun and Clarke 2006) was chosen for its flexibility and ease of use within a less qualitatively experienced research team (Braun and Clarke 2014), as well as the opportunity to systematically identify and interpret patterns across the dataset (Braun and Clarke 2006).  The focus group transcript was read line-by-line, with co-producers working individually or in pairs, to generate the initial coding. Notes were made on both the photographs and the transcript to highlight key topics by all co-producers. Recurrent themes were identified and initial findings discussed. The analysis workshop was audio-recorded but not transcribed in its entirety. However, where co-producers specifically described, expanded upon or clarified meaning associated with a photograph or theme, these conversations were transcribed in context.

Immediately after the workshop, data including the focus group transcripts, transcribed workshop excerpts, photographs and associated notes were imported into the qualitative analysis software NVivo 12 which was used by the academic co-producer for the remainder of the analysis process. Themes were enriched through further coding by the academic co-producer who searched the dataset again for patterns and refined the analysis. The final themes were reviewed by all co-producers.

Results

Three themes were identified: (a) nurturing the Longbridge community; (b) generating social value and social identity; and (c) expressing personal values and identity.  Each theme will be presented in turn with example verbatim quotations and photographs to illustrate their significance. Not all exhibition photographs are included in this paper.

Nurturing the Longbridge Community

The first theme describes the ways in which the Stay and Play volunteers perceive their experience of the Stay and Play as a way of nurturing the Longbridge community, in terms of encouraging the co-producers’ and other ExtraCare village residents’ relationships but also by building relationships with and through the provision of facilities and opportunities for the wider neighbouring Longbridge community. 

Co-producers spoke about how the Stay and Play group had extended their social circles through increased interactions and engagement with each other, children, parents, grandparents and childminders and how much pleasure they gained from those interactions. They described heart-warming interactions and spoke of their joy and how much they cherished these interactions, particularly when children were affectionate or keen to engage with them, for example smiling at them, hugging them, waving at them, or asking them to join in with games or activities. 

I mean the one little boy he hadn’t been for a while, come in, smile on his face,… just come in and just sort of, because he’s only a little dot, put his arms around my legs to give me a hug and it was just his little face, it just lit the whole room up, it was lovely it was. To see the children, it’s just, I mean I know with the grandchildren it’s different because they’re yours, but you see them walking up the path and you just get that, you can’t explain that, that warm, that lovely warm feeling. Sue W

What’s very nice for me, very often when they stay and have coffee here, a drink here, and they walk down the path and I’m on the balcony sometimes, and they’re all waving to me, it’s lovely. Megan

Some of these feelings were apparent in reactions to the photographs, for example, ‘A Vision in Blue,’ (Figure 1) a photograph of a girl painting, generated exclamations of “Lovely little girl” from Megan and a vivid, amusing memory of the little girl’s painting from Sue W “That was the blue painting. That was. She covered the whole paper in blue”. Similarly ‘Surprise’ (Figure 2), a photograph of a little girl  popping out of an upright play tunnel  and surprising her mother and baby brother, generated comments such as “Lovely family” and “She’s lovely” from Lynne, and “I like talking to her” from Sue W. While ‘Parachute Play’ (Figure 3) was more than a depiction of a game, it represented a genuine fondness for the children and the delight in seeing them enjoying their play, and being able to facilitate that play. 

One of the little ones wouldn’t go home the other day because he wanted the parachute and he went and got [name] and he got hold of her hand, and they were standing there hand in hand waiting for the parachute. [Megan]

Figure 1: Vision in Blue

Figure 2: Surprise! 

Figure 3: Parachute Play 

Those feelings of warmth and pleasure through social connections were not limited to the children. The co-producers also spoke about the friendships they had with other adults. When the co-producers were asked whether they thought that being involved in the Stay and Play had made a difference to their social lives, Megan replied:

Oh I definitely do. I definitely do. For me, you know, it’s been so lovely, not only with the children but with the Moms because they’re some lovely girls, really lovely girls and you hear so much nowadays, you know, dreadful things, I mean dreadful things, not giving children the attention and things like that. 

This extract also demonstrates how the Stay and Play group is helping to dispel media driven stereotypes by encouraging relationships between people of different generations. The photograph ‘Meet and Greet’ (Figure 4) was chosen to represent the building of bonds between generations which ultimately fosters an inclusive and diverse community. 

Figure 4: Meet and Greet

The community extended to other residents in the Village, this included ‘the men’ [Sue C], the husbands of two of the co-producers and two other residents.  The co-producers described their role in the community and how much support they provided. 

They’re always there at the end helping as well. Sue W

They are always there. It isn’t only on the day, it’s the day before, the preparing. Megan

And the putting away. Lynne

Clearing away after. Sue C

To capture those supportive relationships between the ExtraCare residents, Megan had taken a photograph of Lynne’s husband Graham, seen in ‘Danger! Man at Work’ in Figure 5.  Graham can be seen moving ‘trees’ (houseplants) around the village in a shopping trolley to help to set the scene for the Teddy Bear’s picnic. The co-producers felt that this picture demonstrated the range of people and tasks involved in making the Stay and Play a success.

Figure 5: Danger! Man at Work

The volunteers were loyal and highly protective of their relationships, social connections and the community they had established, for example Megan had taken a photograph of the pushchairs lined up against the wall at the Stay and Play (Buggy Junction: Figure 6), and while discussing what was meaningful about this photograph, Sue C commented that this photograph “shows that most parents walk”.  The issue here was that there were tensions with some residents who had voiced concerns over the availability of parking spaces. There was general agreement from the co-producers that people accessed the Stay and Play on foot. 

Well the childminders come and there’s two children in the prams, there’s one very often standing at the back, another one on the reins, dragging behind. [Megan]

And they walk quite a way. [Lynne]

For the co-producers, this photograph represented an opportunity to demonstrate their loyalty to both communities, by protecting their Stay and Play community from unwarranted criticism whilst alleviating their ExtraCare Village community’s concerns.

Figure 6: Buggy Junction

Finally, the co-producers spoke about how the Stay and Play acted as a conduit to the Village for the wider community and enabled them to build a more age-diverse community within the Village. They discussed how attending the Stay and Play had enabled people from the local community to familiarise themselves with the Village, its facilities and opportunities. They noted that non-resident childminders, parents and grandparents of children from the Stay and Play now came to the Village to use the gym, take part in social activities and events (e.g. bingo), eat or have a drink in the bistro, and would join residents on day trips, including a recent visit to the seaside resort of Weston-Super-Mare.

Megan, who took the majority of the photographs, stressed that it was important to her that people used the facilities in this way,

Because I like the childminders. They’re so supportive. Even coming in. I mean they go up the corner and they have their coffee and the children play and I think it’s, we need to encourage those people to come here and to know what’s going on. Megan

To reflect the importance of this wider and more diverse ExtraCare community, Megan shared a photograph of the childminders (Waiting for lunch in the bistro: Figure 7) along with the children they looked after waiting for their lunch in the bistro. For Megan, this photograph represented an opportunity to engage with the wider community in an unplanned and spontaneous way, and to bring people into the Village.   

Figure 7: Waiting for lunch in the bistro

Generating Social Value and Social Identity

The second theme describes how the co-producers perceive their experiences of the Stay and Play, as a means of generating social value, as well as a group identity and belonging within the social setting. The Stay and Play provides the co-producers with a social identity in terms of their status within the team (The Three Amigos: Figure 8) and social value as part of a team that transforms the community space through the Stay and Play project. 

Figure 8: The Three Amigos

The co-producers chose to include a photograph, again taken by Megan of three of the volunteers – Lynne, Sue C and Sue W, and titled it ‘The Three Amigos’.  This title is telling; the women have their volunteering in common but they are also friends and socialise together. Although this might initially be suggestive of the first theme, for the co-producers this photograph was not about their community as a whole but rather about valuing and respecting each other as individuals within the team, demonstrated through their matching red uniforms. There was a strong sense of teamwork from the co-producers, albeit with the recognition that Sue C is the driving force, as Lynne stated, “it’s Sue’s baby” and Isobel reinforced “I think that should be emphasised really because it’s organisation that you control between the two of them [Sue C and Lynne] we follow suit”.

The volunteers respect and value each other, and complimented each other on their skills and individual contributions to the Stay and Play, for example, Sue C and Megan remarked about the snacks that Lynne prepares each week

Because the snacks are so beautifully done [Megan]

Well they do say that they’re better than anywhere else, the snacks [Sue C]

Similar comments were also made about Sue C’s organisational skills and play dough, and Isobel’s thoughtfulness and care over the themes of the weekly craft activities. 

There was also a feeling of playfulness and fun amongst the group, and this was depicted using the photograph of Sue C hiding behind the houseplants used to set the scene for the Teddy Bear’s picnic (Come out Sue!: Figure 9). It was clear that the co-producers enjoy each other’s company.

Figure 9: Come out Sue!  

Similarly, there was a shared pride and sense of accomplishment within the group which spanned the lifespan of the Stay and Play, from its creation and set up via a small initial donation, to the delivery of a high quality experience for all attendees, and finally to the growing recognition of their achievements and hard work by their own communities and other organisations.  This shared pride was apparent in some of the remarks made by co-producers comparing their own Stay and Play with others in the local area, particularly when considering the range of activities and hygiene standards. 

Oh no, the standard, the only way I can describe it is that how things are done, is nobody can fault them, from simple things that other people wouldn’t think about but it’s done. [Megan]

I’ve been to two others but the one, the toys were messy and dirty, with no control over the children, they was all running about, the mothers didn’t participate. [Lynne]

Within these extracts, there is social comparison with similar local groups but also a sense of accomplishment and pleasure in seeing the Stay and Play well planned, organised and set up, and so it was natural for the co-producers to want to show the variety of activities they offered. As such, they chose to include photographs of a range of educational activities in their exhibition choices. These included photographs of children involved in water play (Water Play: Figure 10), messy play (Getting Messy: Figure 11) and craft activities (Build a Bear: Figure 12).

Figure 10: Water Play

Figure 11: Getting Messy

Figure 12: Build a Bear

Equally important, and apparent in two of these photographs was the desire to show the volunteers actively engaged in activities with the children, as this was a key point of difference from other Stay and Play groups in the area.

A lot of the Moms say that the other Stay and Plays that they go to, there’s nothing there, is there? And none of the people who run it get involved in it, they just sit back [Sue W]

And they’ve been in and the people who are running it, you know how we do things, they just sit at the table drinking tea and leave the mothers and the children to get on with what they want to do. [Megan]

Being engaged and active was a key part of the volunteers’ social identity within the Stay and Play and was also highly valued in others, as highlighted in the extracts above.  Thus, engagement and active participation were emphasised by the co-producers through multiple comments and the inclusion of the photographs ‘Painting with Nan’ (Figure 13) and ‘Nan’s watching’ (Figure 14) in the exhibition.  These photographs showed a member of the ExtraCare Village actively participating in the Stay and Play group with her granddaughter, painting at an easel and then encouraging hand washing. 

Figure 13: Painting with Nan

Figure 14: Nan’s Watching

In addition to finding meaning in engagement, the co-producers commented on the level of support they received from attendees, for example helping to put out snacks and assistance with tidying up.

And the tidying up […] Yes, because it is because they do help, they go up on the stage and get the, bring the boxes down, don’t they? [Sue W].

What’s so nice here Sue now is when, they know the time when it’s ready for snacks and everything but the mothers help us now. [Megan].

This support was valued by the co-producers, but also appeared to contribute to a sense of their own value, in that people were demonstrating respect and treating them with courtesy by helping. This perception of social value was reinforced through the positive feedback received from parents about the Stay and Play in feedback forms. The group had also received visits from other ExtraCare residents interested in setting up a similar scheme within their own village, which was similarly viewed with delight and an acknowledgement that they had established a successful group. 

Expressing Personal Values and Identity

The third theme illustrates the way in which the co-producers describe their experiences of the Stay and Play as a means of expressing their personal values and identity. When asked about what was meaningful for them, the co-producers highlighted a range of motivations for organising the Stay and Play which were largely underpinned by the core social values of kindness, empathy and helpfulness towards others.

Although the co-producers were specifically asked about loneliness and social isolation, when they described it, it was in historical terms, as echoes of their early parenting years, or alternatively how they perceived others’ social engagement and loneliness potential, particularly some of the parents and children, rather than their own. The co-producers recognised and actively acknowledged the difficulties parents with young children can encounter. The co-producers empathised with the parents and were motivated to try to make things easier for them, specifically than it was for themselves, for example by facilitating introductions so that they could build new relationships and establish support networks. The photograph ‘Getting Acquainted’ (Figure 15) of parents talking in the baby play area was chosen to represent this understanding that being a new parent can be an isolating experience and that a  supportive environment can make a difference. 

The Moms, you know, young Moms especially I think sometimes, you know, when you have little ones, sometimes you feel isolated don’t you and if you’ve got somewhere, I wish I’d had things going on when mine were small like that because it sort of opens it up for the Moms as well. They make friends and make friendships as well. As well as the children sort of getting social skills which is helpful in future life, it’s nice for the Moms. Moms, Grandmas, whoever. [Sue W]

Figure 15: Getting acquainted

All of the co-producers were kind and attentive to parents’ and children’s needs and wants and acted accordingly to meet them. For the children, this might mean ensuring that the play dough was the ‘right’ colour as they often requested specific shades, represented by the photograph ‘What colour is it today?’ (Figure 16), while for the parents this meant giving them an opportunity to rest, sit quietly and spend valuable one-to-one time with their child, suggested by the photographs ‘A Quiet Corner’ (Figure 17) and ‘Special Time Together’ (Figure 18). The photograph ‘A Quiet Corner’ was chosen by the group as it depicts a young boy reading his favourite book ‘The Three Billy Goats Gruff’ with his mother, which had become part of their weekly Stay and Play ritual and demonstrated a touchingly quiet moment in an often busy and noisy environment. Further, the co-producers recognised social, psychological and emotional challenges in parents, for example people who felt low or who were dealing with complex personal circumstances and helped to support them, by talking to them, helping them to integrate and ensuring that they got the best out of their weekly experience. 

Figure 16:  What colour is it today?

Figure 17: A Quiet Corner

Figure 18: Special Time Together

The co-producers also expressed their career and professional values.  For example, Sue C and Sue W were keen to facilitate social and educational development in the children. This appeared to stem from their professional identities and former careers as early years’ and educational practitioners. They spoke about how much they enjoyed contributing their skills and how they enjoyed watching the children grow and develop, becoming more independent, improving in specific skills, for example fine motor skills, and learning to socialise with each other.  There was an understanding that the Stay and Play had benefited the children, through giving them a variety of activities, with options to run around and experience space, toys and activities that might not otherwise be available to them.

They’re not restricted, because at home they might only be like in a small, like a lounge or playroom, and on their own in a lot of cases because they might have an older brother or sister that’s gone to school and they’re walking round and it’s like their own space and wow! It’s a bit of a toy shop, sort of thing. [Sue W]

And the messy play, the Moms wouldn’t want that at home. No. Would you get a big bowl of water out at home? [Lynne]

These comments about the availability of activities were often linked by Sue C to educational development:

Like the activities. Moms probably don’t realise what they’re getting from that.  You know, like the finger movements, the fine finger movements. [Sue C]

This kind of play is all towards writing, they are using their hands [Sue C]

You see water play, and sand play, is all to do, they’re learning measuring, with the cups, and volume [Sue C]

The photograph ‘Chef of the Future’ (Figure 19) was chosen by the group to represent how accessing a range of educational play could support learning and development, and assist a child with the transition to school.  The photograph shows a child using fine motor skills to make ‘food’ out of playdough.

Figure 19: Chef of the Future

Similarly, Sue W commented on how the Stay and Play group enabled the social development of the children:

It’s helping with the social skills as well, it’s interacting with other children as well, not like if they’ve got siblings, they’re not with their siblings, they’re with other children and it’s all part of their development, it’s just so important because they are ready for it in a lot of cases the younger ones, ready for that interaction, so it’s good for them. [Sue W]

The photograph ‘Best Friends’ (Figure 20) was chosen to represent the development of social skills in children and the building of friendships.  It was also meaningful to the co-producers as it showed how one of the girls pictured had developed from being shy and reliant on her mother to becoming more outgoing and independent, and they felt gratified by that change.

Figure 20: Best Friends 

Discussion

This study aimed to determine how co-producers perceive their experience of the intergenerational Stay and Play scheme through the co-production of a photographic exhibition and gain a greater understanding of whether this type of intergenerational scheme can help to address loneliness or social isolation amongst ExtraCare residents. 

The exhibition photographs were selected and categorised into themes, the first of which concerned the community; how individual connections were made, the importance of those connections, community dynamics and cohesiveness, and the maintenance of these connections over time, and through challenges. The narrative power of these images, as chosen by the older adult co-producers demonstrates these factors as well as the joy co-producers gained through their connections. The data show the degree to which the co-producers perceive the Stay and Play group as a means of making and enabling social connections and building relationships, but also as a conduit to the ExtraCare village by the wider Longbridge community. It is this latter finding which demonstrates how the project is helping to counter age-related segregation (Kingman 2016).  While retirement villages offer their residents a range of opportunities, this type of specialist housing does make it harder for different age groups to mix. Further, in cities like Birmingham, age-related segregation is of greater concern than in rural areas due to local population dynamics. Segregation brings with it both economic and social costs, including a reduction in social capital and knowledge transfer opportunities, as well as an increasing reliance on media stereotypes for information (Kingman 2016), as was noted in the first theme. To our knowledge, the examination of intergenerational activities as a means of reducing the growing phenomenon of age-related segregation has not been previously explored.

In terms of the overarching research question examining loneliness and social isolation, although one person commented that belonging to the group had made a difference to their social life, it was apparent that the co-producers were not socially isolated or often lonely, despite a potential vulnerability given some of the co-producers’ socio-demographic status, e.g., female, widowed and living alone (Victor et al. 2005). This finding may be explained in part by their living situation, Holland et al. (2019) noted that the majority (86.5%) of ExtraCare residents were hardly ever or never lonely. However, it may also be related to their larger interpersonal social network structures borne out of their community involvement and volunteering (Cornwell, Laumann and Schumm 2008), particularly as volunteering for more than two hours per week has been found to attenuate loneliness after spousal loss (Carr 2018, Carr et al. 2017). Irrespective, given the limited explicit discussion about loneliness, it would appear that this is not the co-producer’s primary motivation for taking part in the project.   Rather, it appears that running the Stay and Play is associated with eudaimonic wellbeing, that is, achieving self-actualisation, and ensuring that the co-producers had a challenge and an opportunity to utilise their specialist skills, knowledge and lifelong learning to contribute to society and find a role that has become a community-wide asset.

The remaining themes considered identity – social value and identity, and personal values and identity respectively. The co-producers identified very strongly with their social identity as Stay and Play volunteers, as shown by their friendships with other volunteers and matching t-shirts, which have been described by other authors as symbols of commitment and volunteer status (van Ingen and Wilson 2017). They also found meaning and enjoyment in the fact that their efforts were recognised and rewarded by others.  The Stay and Play was instigated, developed and managed by the volunteers, they were not simply passive recipients of an intergenerational activity and it is likely that this active engagement is key in both the success of the project, and the meaning found by the co-producers in the activity.

Meaning and motivations were found across multiple themes. When discussing loneliness, the co-producers were more likely to discuss it in historical terms as echoes of their early child-rearing years and for some, it was this feeling of empathy that motivated them to action. Other authors have similarly noted that empathy is a critical factor in volunteering behaviours in women (Wymer and Samu 2002). There was also evidence that the co-producers recognised feelings of loneliness in parents and realised that the Stay and Play group made a difference to their feelings. Although not pursued in this study, future research might examine the role of intergenerational activity on loneliness in associated but non-target groups, in this example, parents of young children. 

Others’ motivation came from a professional drive and a wish to engage in activities that were a central part of their life before retirement (Choi 2003). Hatton-Yeo (2010) suggests that intergenerational practice has effects on younger people in terms of skill development, friendship and relationship development, and improved confidence and self-esteem.  There was a perception amongst co-producers that the children attending the Stay and Play regularly had indeed developed socially and educationally, for example by making friends and grasping fine motor control. Thus, the Stay and Play project is providing some early years’ education to local children, a number of whom come from low income and disadvantaged families. Since there is a substantial gap in the school readiness of less well-off children and their more advantaged counterparts (Smith et al. 2018), the provision of such opportunities in deprived areas is critical in aiding social mobility. 

In conclusion, this study offered the resident volunteers a fun and creative way to examine the meaning they derived from their experiences of the Stay and Play group, but also a tangible product, through the photographic exhibition, to demonstrate their project’s success and the level of community support they provide. 

Limitations

Only three of the co-producers took photographs, although all of them were shown how to use the cameras and had an opportunity to practice with them. The challenge for co-producers therefore was not the technology but balancing the management of their usual busy schedule and activities, and engaging with the children and parents, with taking meaningful photographs. It may be that in future studies, the co-producers could direct the researcher to take photographs on their behalf to ensure that the images they wanted were captured. 

Given the short study timescales, funding application requirements and all co-producers’ commitments, it was impossible to ensure that this work was truly co-researched across the research cycle. To this end, our approach followed that of Swarbrick et al., (Swarbrick et al. 2016 p.3170) in that we chose to ensure that co-producer “involvement is, first and foremost, meaningful for the individuals themselves”. Therefore, older adult co-producers were involved at the most meaningful stages to them, but arguably also the most critical points – data collection and data analysis.  All co-producers have had the opportunity to read, comment and edit this paper. Our recommendation is that similar future studies embed an additional element of reflexivity to ensure that all perspectives are thoroughly represented throughout.  

Dissemination

The research is being disseminated through the photographic exhibition, which opened in the ExtraCare Longbridge village in November and will tour around other ExtraCare villages ending at the ExtraCare Stoke Gifford village for the British Society of Gerontology (BSG) 2020 annual conference.  Other settings, such as medical practices, other Stay and Play schemes and academic institutions will also be visited.  An article on the launch of the exhibition was published in the ExtraCare residents’ newsletter and distributed nationally.  ExtraCare also prepared a press release but this was not picked up by local or national media.  A paper on the findings of the photo elicitation study has been prepared and submitted to Ageing and Society for consideration. An abstract for an oral presentation has been prepared and submitted to the BSG 2020 annual conference.

Budget Notes

ItemBudget (£)Actual (£)Overspend/ (Underspend) £
3 x digital cameras, cases and memory cards273.67327.5153.84
Printing costs51.2550(1.25)
Stationery costs20.500(20.50)
20 canvas photoprints1127.501100.00(27.50)
20 Easels615399.80(215.20)
Refreshments for focus group, workshop and launch128.13114.10(14.03)
Travel costs for academic co-producer102.5066.92(35.58)
TOTAL2318.552058.33(260.22)

References

Apóstolo, J., Cooke, R., Bobrowicz-Campos, E., Santana, S., Marcucci, M., Cano, A., Vollenbroek-Hutten, M., Germini, F., D’Avanzo, B., Gwyther, H. and Holland, C. 2018. Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review. JBI Database System Rev Implement Rep, 16, 1, 140-232.

Braun, V. and Clarke, V. 2006. Using thematic analysis in psychology. Qualitative Research in Psychololgy, 3, 2, 77-101.

Braun, V. and Clarke, V. 2014. What can “thematic analysis” offer health and wellbeing researchers? International journal of qualitative studies on health and well-being, 9, 26152-26152.

Cacioppo, J.T. and Hawkley, L.C. 2009. Perceived social isolation and cognition. Trends in cognitive sciences, 13, 10, 447-454.

Carr, D. 2018. Volunteering Among Older Adults: Life Course Correlates and Consequences. The Journals of Gerontology: Series B, 73, 3, 479-481.

Carr, D.C., Kail, B.L., Matz-Costa, C. and Shavit, Y.Z. 2017. Does becoming a volunteer attenuate loneliness among recently widowed older adults? The Journals of Gerontology: Series B, 73, 3, 501-510.

Choi, L.H. 2003. Factors Affecting Volunteerism among Older Adults. Journal of Applied Gerontology, 22, 2, 179-196.

Cornwell, B., Laumann, E.O. and Schumm, L.P. 2008. The Social Connectedness of Older Adults: A National Profile. American Sociological Review, 73, 2, 185-203.

Department for Digital Culture Media & Sport. 2018. A connected society: A strategy for tackling loneliness. HM Government, London

Finlay, L. 2014. Engaging phenomenological analysis. Qualitative Research in Psychology 11, 2, 121-141.

Fratiglioni, L., Wang, H.-X., Ericsson, K., Maytan, M. and Winblad, B. 2000. Influence of social network on occurrence of dementia: A community-based longitudinal study. The Lancet 355, 9212, 1315-1319.

Gualano, M.R., Voglino, G., Bert, F., Thomas, R., Camussi, E. and Siliquini, R. 2018. The impact of intergenerational programs on children and older adults: a review. International Psychogeriatrics, 30, 4, 451-468.

Guillemin, M. and Drew, S. 2010. Questions of process in participant-generated visual methodologies. Visual Studies, 25, 2, 175-188.

Gullette, M.M. 2004. Aged by culture. University of Chicago Press, Chicago.

Gwyther, H., Bobrowicz-Campos, E., Apóstolo, J., Marcucci, M., Cano, A. and Holland, C. 2018. A realist review to understand the efficacy and outcomes of interventions designed to minimise, reverse or prevent the progression of frailty. Health Psychology Review, 12, 4, 382-404.

Harper, D. 2002. Talking about pictures: A case for photo elicitation. Visual Studies 17, 1, 13-26.

Hatton-Yeo, A. 2010. An introduction to intergenerational practice. Working with Older People, 14, 2, 4-11.

Health Quality Ontario. 2008. Social Isolation in Community-Dwelling Seniors: An Evidence-Based Analysis. In Ontario Health Technology Assessment Series (ed), 1-49.

Higgins, S. and Highley, B. 1986. The Camera as a Study Tool: Photo Interview of Mothers of Infants With Congestive Heart Failure. Children’s Health Care, 15, 2, 119-122.

Holland , C., Carter, M., Cooke, R., Leask, G., Powell, R., Shaw R. L., West, K., Clarkesmith, D., Collins, J., Hagger, B., Kay, A., Lambie, J., Liddell, L., Wallis, S. and Boukouvalas, A. 2015. Collaborative research between Aston Research Centre for Healthy Ageing (ARCHA) and the ExtraCare Charitable Trust In  Aston University and ExtraCare Charitable Trust Birmingham, https://www2.aston.ac.uk/lhs/research/centres-facilities/archa/extracare-project.

Holland, C., Garner, I., O’Donnell, J., Gwyther, H. 2019. Integrated homes, care and support. Measurable outcomes for healthy ageing. The ExtraCare Charitable Trust

Holt-Lunstad, J., Smith, T., B.,, Baker, M., Harris, T. and Stephenson, D. 2015. Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review. Perspectives on Psychological Science, 10, 2, 227-237.

Iliffe, S., Kharicha, K., Harari, D., Swift, C., Gillmann, G. and Stuck, A.E. 2007. Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people. British Journal of General Practice, 57, 537, 277-282.

Jenkinson, C.E., Dickens, A.P., Jones, K., Thompson-Coon, J., Taylor, R.S., Rogers, M., Bambra, C.L., Lang, I. and Richards, S.H. 2013. Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers. BMC Public Health, 13, 1, 773.

Kingman, D. 2016. Generations Apart: The growth of age segregation in England and Wales. In  London: The Intergenerational Foundation, http://www.if.org.uk/wp-content/uploads/2016/09/Generations-Apart_Report_Final_Web-Version-1.pdf.

Perlman, D. and Peplau, L.A. 1982. Theoretical approaches to loneliness. In Peplau, L.A. and Perlman, D. (eds), Loneliness: A sourcebook of current theory, research and therapy. John Wiley and Sons New York, 123-134.

Samuels, J. 2004. Breaking the Ethnographer’s Frames: Reflections on the Use of Photo Elicitation in Understanding Sri Lankan Monastic Culture. The American Behavioral Scientist, 47, 12, 1528-1550.

Smith, G., Sylva, K., Sammons, P., Smith, T. and Omonigho, A. 2018. Stop Start. In  London: Sutton Trust http://www.suttontrust.com/research-paper.

Swarbrick, C.M., Doors, O., Educate, Davis, K. and Keady, J. 2016. Visioning change: Co-producing a model of involvement and engagement in research (Innovative Practice). Dementia, 18, 7-8, 3165-3172.

Valtorta, N.K., Kanaan, M., Gilbody, S., Ronzi, S. and Hanratty, B. 2016. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies Heart, 102, 1009-1016.

van Ingen, E. and Wilson, J. 2017. I Volunteer, Therefore I am? Factors Affecting Volunteer Role Identity. Nonprofit and Voluntary Sector Quarterly, 46, 1, 29-46.

Victor, C.R., Scambler, S.J., Bowling, A. and Bond, J. 2005. The prevalence of, and risk factors for, loneliness in later life: a survey of older people in Great Britain. Ageing & Society, 25, 6, 357-375.

Wang, C. and Burris, M.A. 1997. Photovoice: concept, methodology, and use for participatory needs assessment. Health education and behaviour, 24, 3, 369-387.

West, K., Shaw, R., Hagger, B. and Holland, C. 2017. Enjoying the third age! Discourse, identity and liminality in extra-care communities. Ageing & Society, 37, 9, 1874-1897.

Wymer, W. and Samu, S. 2002. Volunteer Service as Symbolic Consumption: Gender and Occupational Differences in Volunteering. Journal of Marketing Management, 18, 9-10, 971-989.

Appendix 1: Semi-structured questions for the focus group workshop. 

Please have a look at the photographs and choose those that best represent your Stay and Play experiences so far.

•             What does this photograph specifically represent for you?

•             How does this photograph make you feel?

•             What or who is it in this photograph that you relate to? And how?

•             Have your experiences of the Stay and Play project affected your social life? How?

•             Have experiences of the Stay and Play project affected your wellbeing? How?

•             Have you ever felt lonely or socially isolated? *Prompt, if so how does attending the Stay and Play scheme affect those feelings?

•             Which photographs hold the most meaning for you, as individuals and as a group? Why?

•             Which photographs should be included in the exhibition? Why?

•             Given that we can only display 20 photographs, how should we decide which photographs to use? Prompt: Perhaps we could vote using a sticker system for your favourite/most meaningful photograph(s)?

*Please note that this question will only be asked if the previous questions around social life and wellbeing do not prompt discussions around loneliness/social isolation.