Understanding how, why and for whom link work interventions promote access in community healthcare settings in the United Kingdom: A realist review.

Introduction:
Inequity in access to healthcare in the United Kingdom can have a profound impact on people’s ability to manage their health problems. Link work interventions attempt to overcome the socioeconomic and structural barriers that perpetuate health inequalities. Link workers are typically staff, without professional clinical qualifications, who support patients to bridge the gap between services. Little is currently known about how and why link work interventions might be effective. This realist review attempts to understand the contexts and resultant mechanisms by which link work interventions affect access to community healthcare services.

Methods:
The authors completed a systematic search of empirical literature in Embase, CINAHL, Medline, PsychInfo and SocIndex, as well as grey literature and CLUSTER searches. Context, mechanism, and outcome (CMO) configurations were generated iteratively in consultation with an expert panel and grouped into theory areas.

Results:
31 eligible manuscripts were identified, resulting in nine CMO configurations within three theory areas. These pertained to adequate time in time pressured systems; the importance of link workers being embedded across multiple systems; and emotional and practical support for link workers.

Conclusion:
Although link work interventions are increasingly being utilised across community healthcare settings, the contexts by which they operate vary considerably, triggering a range of mechanisms. The findings suggest careful matching of resource to patient need and complexity, affording link workers the time to develop relationships with patients, embed themselves in local communities and referring teams, and develop knowledge of local challenges.

Patient or Public Contribution:
The team included people with lived experience of mental health conditions and a carer, involved at all stages of the review.