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A literature review
Institute for Volunteering Research
Jonathan Paylor
October 2011
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The Institute for Volunteering
Research
The Institute for Volunteering Research (IVR) is a specialist research and
consultancy agency focusing on volunteering. It was set up in 1997 in
response to the increased demand for research on volunteering. Since then
IVR has carried out a wide variety of research, consultancy and evaluation
projects on many different aspects of volunteering, including four national
surveys of volunteering.
1
Contents
Executive summary 3
1. Introduction 5
2. Method 6
3. Health 7
3.1 Impact 7
3.2 Implications 9
4. Public health 11
4.1 Impact 11
4.2 Implications 11
5. Social care 14
5.1 Impact 14
5.2 Implications 16
6.1 Impact 20
6.2 Implications 23
7. Characteristics of volunteers 27
8. Conclusions 28
Bibliography 30
2
Executive summary
This literature review has been conducted to inform the Department of
Healths strategic vision for volunteering in health and care. The review
explores literature in four key areas: health; public health; social care; and the
broader health and well-being impacts of volunteering. The review examines
the evidence around the impact of volunteering and draws out the implications
for policy and practice.
The literature reveals how volunteers are involved in a wide range of settings
across health, public health and social care, and are integral to the functioning
and maintenance of the services provided. Research demonstrates that the
value of volunteers not only lies in increasing the capacity of the workforce,
but also in the special qualities they bring, which complements the work of
paid staff and provides a more satisfying experience for service users.
The benefits of volunteering also spill over into the wider community.
Research shows that public participation in shaping and delivering services
increases community resilience, as people become more active in their
communities and provide mutual support for each other.
3
Volunteers should be offered multiple, flexible opportunities which feed
into their individual needs and wishes and, moreover, be provided with
an adequate level of training and support.
4
1. Introduction
This literature review has been conducted to inform the Department of
Healths strategic vision for volunteering in health and care. The aim of the
review is to provide a background to volunteering in health, public health and
social care. The review will also signpost leaders and practitioners within local
authorities, NHS Trusts and other organisations to research that will help
inform their own local decision-making around volunteering initiatives.
The review was primarily designed to explore literature in four key areas:
health, public health, social care and the broader health and well-being
impacts of volunteering. The focus was to examine the evidence around the
impact of volunteering and to draw out the implications for policy and practice.
Reflecting the diversity of the social care sector, the section on social care
focuses on the involvement of volunteers in a number of different supporting
and caring roles and social care interventions. These include befriending
schemes, peer-support, respite care and short-term breaks. In addition to this,
studies which have examined community-based and co-production models
(an approach in which service users become active participants in developing
services) are also discussed.
Finally, the review summarises the themes emerging from the literature and
draws out the key issues that organisations need to consider when setting up
and implementing a volunteering initiative.
5
2. Method
The first stage of the review consisted of comprehensive key word searches in
Google scholar for the years 2008-2010 around volunteering and
participation in the four key areas. This was followed by more detailed
searches of relevant journals, organisations, research groups and individuals.
The searches produced a range of results, from which 27 relevant texts were
obtained. These included literature reviews, research reports / summaries,
academic papers and consultancy reports. The focus was on England, but
some relevant UK wide and international studies have also been included.
A further search was carried out in the Institute for Volunteering Researchs
(IVR) Evidence Bank1 to identify IVRs previous research around volunteering
in the health and social care fields. Thirteen relevant studies dating back to
2000 were obtained.
Relevant references and citations in the literature were also followed up and,
in response to emergent themes, a number of additional key word searches
were conducted around time banking, co-production, respite care and
short breaks. These produced a range of results, from which a further
number of relevant texts were obtained and reviewed. In total, 64 texts
informed the final literature review.
1
www.ivr.org.uk/evidence-bank
6
3. Health
3.1. Impact
The findings varied across the trusts and each evaluation should be treated as
an individual case study. However, a number of underlying and key benefits of
volunteering that emerged from the overall project can be identified:
7
The economic value of volunteering averaged around 700,000 per
annum in acute hospital trusts, 500,000 per annum in mental health
trusts and 250,000 per annum for the primary care trust (Teasdale,
2008). A further analysis showed that a nominal 1 investment in a
volunteering programme yielded an average return of between 3.38
and 10.46.
Participation
In the studies above, the volunteers who participated were, in the main,
involved in delivering a service. Other studies have paid closer attention to
volunteering opportunities that go beyond service delivery and move towards
participation in planning, consultation and research within health care services
(Gay, 2005;2006; Howe, et al 2009; Macdonald, 2009).
A notable piece of work is Gays research into participation in the NHS (2005;
2006). Based on interviews with senior managers from a primary care trust,
an acute trust and social care services, Gay explores the impact of the
governments drive to increase public and patient participation. In doing so,
she identifies a range of opportunities, such as being a member of an advisory
group, that have enabled the public and patients to air their views, help
develop services, monitor their provision and actively shape the organisation.
Gay concludes that, if properly conducted, such participation can lead to a
loosening of the bureaucratic grip, resulting in policies that empower local
people and allow them to take part in decision-making processes.
Hospices
Echoing IVRs analysis of volunteering within the NHS, there are a number of
studies which highlight the vital role that volunteers play in supporting
hospices. Davis Smith (2004), for instance, demonstrates that volunteers are
involved in all aspects of hospice life, in a wide variety of roles. Without this
input, he concludes that hospices would not be able to operate; at least, not
on the scale that they currently do.
8
3.2. Implications
Volunteer management
In the main, across IVRs series of NHS evaluations and studies that examine
the involvement of volunteers in hospices, it is reported that the management
of the volunteers reflected good practice and the volunteers were generally
positive about their support and management.
Managing participation
A significant issue raised in Gays (2005; 2006) research is that the success of
participation is largely dependent on senior managers overcoming their
reluctance to embrace lay participation. Within the trusts she researched,
participation initiatives were initially stifled due to senior staff feeling that their
authority was challenged and that participants had little understanding of the
health service. She notes, however, that as a result of the introduction of new
policies and strategies, there has been a shift in attitudes and understanding.
Consequently, participation initiatives have moved forward and proven to be
more successful.
Another key theme to emerge from Gays work revolves around the model of
management most appropriate for public participation. Within the trusts she
studied, standard volunteer management techniques were, in the main,
applied to manage the participants. Although Gay shows these provided a
valuable framework and were in some respects vital to the success of the
programme, she highlights the differences between participation and
traditional service delivery volunteering.
9
This ultimately raises questions regarding the extent to which traditional
management principles should guide the management of participation.
In not providing a conclusive answer and noting that there is little research on
participation within the NHS and knowledge of best practice, Gay puts forward
a number of points to consider:
10
4. Public health
4.1 Impact
There are only a few articles which discuss volunteering directly in reference
to public health. A significant study is South et al's (2010) People in Public
Health. Through carrying out a literature review and a number of case studies,
along with obtaining expert hearings, they provide a detailed account of public
involvement in delivering public health programmes. In doing so, they identify
a range of roles, such as community health educators and health advocates,
which lay people, often on a voluntary basis, take on.
4.2. Implications
A key theme to emerge from Gays (2005) study was that, while there were
many innovative public health initiatives delivered by the voluntary sector, the
work was patchy, hampered by a lack of funding from the statutory sector and
lacking strategic direction.
To address these issues, Gay suggests that the County Council needs to
establish a policy with regards to voluntary organisations and health
promotion, and in doing so, look into developing avenues of funding. This
proposal, along with the studys findings, must be understood in relation to the
specific context of the research. The study, however, raises important issues
which need to be considered in the development of partnerships between
voluntary organisations and local government.
11
In light of their findings, South et al (2010) suggest that lay workers and
volunteers can make a valuable contribution to the delivery of public health
programmes and argue that such approaches need to be considered as a way
of addressing persistent health inequalities. They put forward a number of
recommendations to inform and develop future policy and practice. These
include:
Policy issues
There needs to be greater recognition of the contribution of active
citizens to public health across all the different levels of engagement,
from helping out through to community leadership
There is scope for developing a framework that adequately reflects the
social skills, knowledge and qualities that lay workers bring to their
roles
Simple protocols are needed that provide guidance on how
volunteering, sessional payment and welfare benefits fit together.
12
Although the evaluations findings and the proposals must be interpreted in
relation to the specific research context, they do have wider relevance and
point to issues that other public health volunteer programmes may also face.
13
5. Social care
5.1. Impact
This lack of evidence of effectiveness, however, does not mean that services
are ineffective. As Arksey et al (2007) point out, undertaking studies of respite
services is particularly complex, with a number of significant conceptual and
methodological challenges. Furthermore, they note that there is a
considerable amount of qualitative evidence from carers and some from
care recipients of the perceived benefits of respite services.
14
The report concludes that such initiatives provided parents with the
opportunity to recharge their batteries, have some normality and give more
attention to siblings. At the same time, these services provided the children
with the opportunity to engage in activities they wouldnt necessarily be able to
do at home, to interact with other children and to gain some independence.
Befriending
A social care intervention that volunteers have also been central to is
befriending (Mead et al, 2010; Bradshaw and Haddock, 1998; Harris et al,
1999; McGowan and Jowett, 2003; Mentoring and Befriending Foundation,
2010). The literature explores a range of different befriending models, each
providing a particular function in particular settings. There are, however, some
central characteristics to the befriending role.
The value and impact of peer support in a different social care setting is
highlighted in Goddards (2005) study at a large cancer charity into personal
experience volunteers (volunteers who have personal experience, past or
present, of the problem or issue that they hope to address or prevent through
their volunteering). The study shows that the volunteers had a significant
impact on the organisation and the recipients they supported through
contributing experiences, skills and knowledge based on their own experience
of cancer.
15
Participatory approaches to shaping and delivering social care
There are number of studies which have reviewed participatory and co-
production approaches to shaping and delivering social care services.
5.2. Implications
16
In light of her findings, Goddard suggests that practitioners involving personal
experience volunteers should:
A significant theme also to emerge from Littlechild et als (2007) study is the
issue of accessibility. Here, they demonstrate the need for organisations to be
responsive and to put in place effective information systems that keep carers
informed of the services on offer, particularly for disengaged groups, such as
ethnic minorities.
The studies all stressed that the quality of provision provided by staff or
volunteers is central to the effectiveness of the service. Lewin et al (2009), for
example, in their analysis of respite carers working with older people,
demonstrate that carers need to be sensitive and respectful, acknowledging
the individuality of the recipient. Moreover, they argue that carers need to be
able to form good trusting relationships with the recipient as well as the
informal carers such as husbands, wives, adults or children.
17
Investing in befriending
A significant theme across the literature on befriending is the potential of such
initiatives to provide a cost effective way of delivering social care. Drawing on
research which shows that befriending schemes can prevent depression,
Knapp and Perkins (2010) argue that investing in such schemes at the local
level may delay the need for more costly health and social care service
provision.
With this in mind, Fenner and Martin argue that when developing a user
driven organisation, groups need to engage in dialogue and find ways of
sharing knowledge, ensuring that the aim or purpose reflects the shared
experience of those involved and where they want to go together.
Across the literature on navigator type roles, there are a range of models,
each possessing their own design and objectives. Without wanting to flatten
these distinctions, from reviewing their implementation, a few of key factors
were shown to be central to the effectiveness and development of such
approaches:
18
Although their findings show that the approach has positive outcomes for
disabled people, Appleton et al argue that there is little evidence that it is cost
effective. Subsequently, they suggest that, in the context of Darlington, rather
than investing in LAC, the local council should improve and invest in existing
services provided by the voluntary sector and incorporate some of LAC
principles.
19
6. Individual and community
well-being
6.1. Impact
Perceptions of self
Perceptions of self refers to how volunteering can shape the way that people
think about themselves. This is illustrated in a recent study which explored
environmental volunteering (Obrien et al, 2008). Here, volunteers expressed
that through contributing to a good cause, they gained a sense of satisfaction
and felt good about themselves. Furthermore, they saw their participation as a
constructive way to spend their time, providing them with a sense of purpose
and increased feelings of self esteem and self confidence.
Social integration
Social integration refers to how volunteering connects people with other
people and provides the building blocks of social capital. There are a number
of studies which point to the health benefits of this. Konwerski and Nashman
(2008), for instance, show that through meeting new people and reaffirming
established social contacts, volunteers gain a sense of belonging and feel
connected to the wider society. This in turn is seen to combat depression
associated with loneliness.
20
Significantly, in light of concerns regarding social isolation amongst elderly
people, studies highlight how social integration and gaining a sense of
belonging is a chief benefit of volunteering for older people (Age Concern,
2010; Warburton, 2006; Lee and Brudney, 2008; Volunteer Development
Agency, 2009). Such benefits have also proved to have been valuable to the
recovery of people who have experienced mental health problems (CSV,
2008).
Co-production
The notion of social capital and ideas surrounding community capacity and
resilience have informed much of the literature which focuses on lay
participation and co-production models of delivering public services. In a
recent report, Boyle et al (2010) argue that the involvement of the public and
local people in shaping and delivering public services not only creates a
person-centred service which is more responsive to the needs of local people,
but also fosters a sense of responsibility and community activism where
people take control of their own lives and local services, create and develop
social networks and galvanise resources from the local community. For Boyle
et al this, in turn, strengthens community resilience, promotes well-being and
undermines the culture of dependency on statutory services.
21
Likewise, community navigator type roles, such as the Local Area Co-
ordinator (Hudson, 2010; Stalker et al, 2008) play a valuable role in building
bridges between families and individuals and guiding people to utilise the
informal networks of support within their community, thereby reducing
dependency on statutory services.
Time banking
Time banking is an initiative championed for being a practical tool that
stimulates co-production. First conceived by the North American Edgar Cahn,
time banks have been used in the UK since 1998 in a range of settings and
across different public services (Seyfang, 2002; Boyle, 2003; Ryan Collins et
al, 2008). There are a range of models (person-to-person, person-to-agency,
agency-to-agency), but all are based on the fundamental premise that people
offer their time and skills to others in exchange for time bank credits (one hour
equals one time credit). People can use their earned credits to buy time from
others; this can be in areas in which people feel they lack skills or do not enjoy
pursuing.
There are a number of case studies that illuminate the value and impact of
time banks (Warden, 2009; Warne and Lawrence, 2009: Gould, 2006; Seeley
and Bond, 2005; Seyfang, 2004). One time bank that has received a great
deal of attention is the Rushey Green Time Bank (RGTB) (Ryan Collins et al,
2008; NEF, 2001; NEF, 2002).
22
Increasing an individuals contact with other people and thus tackling
symptoms of isolation and depression
Widening and strengthening support networks and fostering community
based self-help
Reducing the burden on the GP and the other traditional carers from
social services.
6.2. Implications
Recognising complexity
While there is a large amount of evidence which shows that volunteering has
a positive impact on the health of individuals and communities, there are a
number of dynamics which complicate this relationship. For instance, in an
evidence review, Kroll (2010) identified research which revealed that mothers,
as a societal subgroup, actually do not benefit from voluntary activity in terms
of increased life satisfaction. She points to another study carried out which
might help explain this phenomenon which she calls the motherhood penalty.
According to the study, mothers frequently reported having a guilty
conscience when volunteering because they felt that they were neglecting
their family responsibilities.
The work of Kroll (2010) and Sixsmith and Boneham (2003) points to the need
for a more nuanced approach to understanding the benefits associated with
volunteering, recognising how they vary between different groups and are
shaped by the specific context.
Investing in volunteering
Within the context of an ageing population, and fears about increasing
depression and growing health inequalities, some argue that the government,
voluntary and community sectors, public and private organisations must
prioritise volunteering and see its value in promoting and maintaining good
health, particularly among older people and mental health patients (CSV,
2008; Lee and Brudney, 2008; Age Concern, 2010). In considering this
overarching argument, there are a number of implications and issues in
relation to policy and practice which also need to be recognised and engaged
with.
23
Hill and Westrip (2010) argue that while investment is welcome in activities
such as volunteering, it is important to be aware of the dangers of more formal
state funding, as this can lead organisations to become over formalised,
bureaucratic and subsequently, lose their effectiveness in providing the kind of
informal activity which has an impact on an individuals well-being. They
therefore tentatively suggest that the way forward is a mode of state funding
which will allow organisations full autonomy.
Reconceptualising volunteering
In recognising that volunteers receive important well-being benefits when they
contribute to the welfare of others, Aked (2011) suggests that policy makers
should embed the ideas of reciprocal exchange into an understanding of
volunteerism. For Aked, this requires the creation of opportunities based on
alternative models such as co-production and a shift from seeing volunteering
solely in terms of charitable giving, to acknowledging the mutual exchange
that exists between people and organisations.
In relation to practice, Konwerski and Nashman (2008) also suggest that ideas
of reciprocal exchange should inform and direct the management of
volunteers. Significantly, to maximise the sense of well-being that volunteers
gain through volunteering, Konwerski and Nashman stress that managers
need to make sure that volunteers feel they are part of a mission driven
organisation and have a stake in reaching its goals; moreover, the goals of the
organisations should feed into the volunteers needs, interests and aims.
In terms of management, Lee and Brudney (2008) suggest that there needs to
be adequate training and support provided by a manager who possesses
special knowledge and understanding of the older generation.
24
Significantly, CSV (2008) proposes that opportunities, projects and support
should be developed around individuals and communities needs and
interests and that there should be a focus on building reciprocal relationships
between the volunteer and the organisation. In relation to support and
management, IVR (2003) further highlights the importance of reimbursing
expenses and providing regular support and supervision by people with good
interpersonal skills and knowledge of the implications of mental ill health.
Their study reveals that the awareness of mental illness amongst all staff in
organisations is also central to the engagement and retention of volunteers.
Investing in co-production
In their recent report, Boyle et al (2010) argue that co-production provides a
powerful alternative to the conventional model of public service delivery, which
in their view has a tendency to disempower people who are supposed to
benefit from services, to create waste by failing to recognise service users
own strengths and assets and to engender a culture of dependency that
stimulates demand. For them, co-production has the potential to transform this
model and be better positioned to meet the current challenges facing society,
including public spending cuts, an ageing population and increasing numbers
of those with long term health conditions. Moreover, they see the co-
production model as a way to realise the governments vision of a Big Society.
In making such claims, Boyle et al propose that the core values and features
of co-production recognising people as assets, building on peoples existing
capabilities, promoting mutuality and reciprocity, building social networks,
breaking down barriers between professionals recipients, and facilitating
rather than delivering should become part of mainstream planning across
public services. This would involve:
25
It is important to keep in mind that the time banking model is flexible and that
there is no one correct model. Nevertheless, the reviews and evaluations of
time banks often identify the common and key characteristics of programme
success, which can help inform future practice. Significantly, in their
evaluation of UK time banks, Seyfang and Smith (Seyfang, 2002) determined
that time banks were more likely to succeed if they: adapted to their local
situations; created a strong local presence; secured adequate funding; were
based in a local organisation; offered incentives to participants; and
developed the social side of the project.
26
7. Characteristics of
volunteers
In the main, the people who volunteered and participated in the initiatives
discussed in the literature come from a rather narrow stratum of society.
Concerns about the diversity of volunteering are raised by Davis Smith (2004),
who found that volunteers within the hospice movement tended to be female,
white and over 55 years of age. Davis Smith (2004) does not conclusively
explain why this is so, but tentatively suggests that this type of volunteering is
more attractive to this group of people, as older people are more likely to
come into contact with hospices through the care they provide for family and
friends. Moreover, he also points to the possibility of a cloning effect going
on, where the heavy reliance on word of mouth as a recruitment mechanism
leads to volunteers recruiting other volunteers in their own image. In light of
these findings, he proposes that hospices should explore new avenues and
adapt their practices and procedures to engage the interest of men, young
people, and people from black and minority ethnic communities.
The lack of diversity is not just restricted to hospices, but is also evident in
volunteering across the NHS (Teasdale, 2008; Teasdale, 2007a; Teasdale,
2007b; Teasdale, 2007c; Teasdale, 2007d; Teasdale, 2007e; Gerry, 2007).
For instance, although there were variations across the case studies, on the
whole, the volunteers who participated in IVRs series of evaluations were
generally, elderly, white and female a finding repeated in Howlett and
Lukkas (2000) evaluation of the public health programme, Walking for Health.
27
8. Conclusion
This literature review has revealed how volunteering is embedded in a range
of settings across the NHS, public health programmes and the social care
sector, and that the volunteer roles and tasks are diverse and multiple,
ranging from supporting and caring roles, advisory roles, to participation in
decision-making processes. Significantly, a number of studies have also
highlighted that current or previous patients and service users are holding
such positions.
The benefits of volunteering are not restricted to the patient, organisations and
staff. A dominant theme across the literature is that volunteering has a
positive impact on the volunteer. Volunteering is seen to provide volunteers
with a sense of satisfaction and self esteem and an increased stock of social
capital. In relation to social capital, studies have pointed to how the benefits of
volunteering spill over into the wider community. More specifically, research
has shown how volunteering can increase community capacity and resilience,
as people help each other out and draw on resources from within their local
community.
It must be recognised that the literature does not provide a complete picture
and that there is a need to further develop the evidence base around the
value of volunteer involvement. Nevertheless, the multiple impacts of
volunteering revealed through the literature do provide a compelling argument
for embracing and investing in volunteering. How best can organisations take
on this agenda and cultivate the benefits of volunteering?
28
What is apparent from the literature is that there are a wide range of
volunteering roles set within a variety of contexts, each with differing
objectives, impacts and management needs. It would therefore be wrong to
suggest that there is a single, correct approach and volunteering model to
follow. Rather, what the literature points to is the need to adopt an approach
and model which is tailored to the local and organisational context.
Although there are differences between the multiple volunteering roles and
initiatives discussed in this review, a number of underlying and key points
emerge from the literature to consider when setting up and implementing a
volunteer programme:
29
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