This project aims to establish the conditions for scalability of non-pharmaceutical cultural and natural heritage interventions in remote and rural areas. Exercise groups, outdoor activities, art therapies and peer support are increasingly being 'prescribed' to 'treat' both mental health conditions and address sedentary lifestyles. However, little has so far been done on how to deliver them at scale in remote and rural contexts. 17% of Scotland's population live in rural areas. Service providers face economic and logistical challenges delivering across large geographical areas with dispersed populations. Although rural communities can be perceived as tight-knit and resilient, the problems of mental ill-health, social isolation and deprivation can be hidden. However, rural areas have many natural and cultural assets on which non-pharmaceutical 'treatments' can be based to benefit a wide range of patients. Our study will focus on how to overcome challenges for service commissioners and planners; how to improve referral pathways to increase take up of non-pharmaceutical services; tackling delivery challenges faced by third sector providers; and identifying contextual factors determining the effective scaling up of non-pharmaceutical heritage interventions. We will identify the key conditions, mechanisms and contexts needed to scale up the prescription of these interventions so they can form part of mainstream health provision. To achieve this, we will explore scaling up from multi-stakeholder perspectives using qualitative research methods in conjunction with a scalability assessment. We will build our research around the 'Prescribe Culture' programme, developed by the University of Edinburgh, and use it as the basis to test scaling up in remote and rural areas. The cultural programme will be delivered both online and face to face with hands on workshops led by rural museums across the Highland region. Nature-based activities will also be led by countryside rangers. Focusing on this cultural and natural heritage intervention, we will look in detail at service planning/commissioning, referral, delivery, marketing and impact on providers, professionals and patients. Qualitative research methods such as interviewing will enable us to examine the challenges of scaling up from all angles along the social prescribing pathway. This mixed methods study will include a scalability assessment. A steering group of decision-makers, service planners and representatives from the voluntary sector will help inform the scalability assessment. Following a literature and policy review, we will interview or hold focus groups with steering group members, health professionals, community link workers, intervention facilitators and participants. In NHS Highland, Community Link Workers (CLWs) will be embedded in GPs practices in an attempt to reduce health inequalities. Located in areas of deprivation, CLWs will help patients to identify appropriate non-clinical activities or support. The heritage intervention will be delivered in areas where these CLWs are based. Outputs will include a final report, peer-reviewed publication, conference presentation, virtual exhibition of workshop material and a short film to raise awareness about social prescribing. A social prescribing 'fair' will be organised for the public and health professionals, so third sector providers can showcase a range of non-pharmaceutical interventions. Engagement with decision-makers and service providers is a key aspect and delivered via the steering group of representatives from NHS Highland, Highland Council and the third sector. We will develop a set of recommendations to help inform scaling up of services. We will disseminate findings through a range of organisations such as the NHS, Scottish Parliament Cross-party Working Group on Health Inequalities, Scottish Rural Health Partnership, Scottish Social Prescribing Network and Voluntary Health Scotland (VHS).

REALITIES (Researching Evidence-based Alternatives in Living, Imaginative, Traumatised, Integrated, Embodied Systems) is a collective of lived and felt experience community researchers already embedded within three localities in Scotland (Clackmannanshire; Easter Ross in the Highland; and North Lanarkshire); local council representatives; third sector organisations; artists; environmentalists; Scottish national dance, theatre and singing bodies; an executive non-departmental public body of the Scottish Government; and academics from diverse disciplines including health policy; health economics; mental health nursing; counselling, psychotherapy and applied social sciences; new public management; human geography; environmental sociology; design innovation and participatory design; and the arts. Our life experiences, work in communities and research has made us accept that we're part of a fragmented, traumatised system. Guided by Karen Treisman's thinking on organisational trauma, we're seeing the system as the 'client' or 'vulnerable participant' or 'deprived person' with 'lived experience'. Burnt out and suffering from compassion fatigue, the traumatised system polarises people, places and processes. It's crisis driven; avoidant or detached emotionally to cope with insurmountable global inequities. It's chaotic; dysregulated; disconnected. Our multi-site collaboration will co-design and test the scalable REALITIES model - to piece together the fragmented parts of the system to bring about integrated systemic change through conscious and co-ordinated engagement in hyper-local communities - using a multi-faceted approach that connects people, places, processes and power. We'll think differently and creatively about divergent perceptions of reality (ontology); different types of knowledge and evidence (epistemology) in the system (for example, how dance movement can sit alongside a statistical analysis); and we'll explore the ethics of vulnerability (who decides who is and isn't vulnerable and what does this label mean for the so-called vulnerable?). We're also uniting academics from multiple disciplines, who use diverse methodological approaches to analyse health disparities, and bringing them into deep, critical conversations about data, methods, theories and analysis. The REALITIES model will take us towards methodological convergence (or help us find ways to integrate methodological divergence) that situates participatory, arts-informed, creative-relational, (post)-qualitative approaches alongside positivist, scientific approaches in the evidence-base. In summary, our team will: i) facilitate cross-partner collaborations in three localities - Clackmannanshire; Easter Ross; and North Lanarkshire (NL) - to establish multiple, clearly defined asset hubs in these neighbourhoods. The hubs have focus on creatively connecting employability, health and social care (particularly mental health), transport accessibility, community learning and development, and the environment. ii) map and investigate how Integrated Joint Boards in these localities work with non-statutory community groups to connect cultural, natural, social and creative-relational assets to address health disparities; iii) explore how excluded communities in the system - 'The Outliers' - namely prisoners, ex-offenders, refugees and those experiencing homelessness are integrated within statutory and non-statutory services and partnerships in these localities; iv) co-design and explore the new scalable REALITIES model across emergent asset hubs in the three localities to understand how we can collaboratively create healthier communities across Scotland.

The proposal focuses on the contact with cinema during 1946-71 by isolated, religiously- conservative, linguistically-distinctive and economically-vulnerable communities in the Highlands and Islands. This contact divided communities, threatened the Gaelic language, and it was feared, fostered young people's desire to out-migrate. The project seeks to explore this in detail, before the generation that experienced it dies out. The formation of the Highlands and Islands Film Guild continued a pre-war initiative of the Scottish Film Council to make non-commercial cinema available to rural areas through the substandard gauge of 16mm. This continued during the second world war via the Ministry of Information and the Evacuation Film Scheme. The Film Guild was proposed to counter depopulation and improve leisure facilities for remote communities forming part of wider economic and cultural initiatives to bolster community activity, cohesion and recreation. It is a widely remembered but still unwritten part of Scottish cinema history in the period stretching from before television and extending into its early penetration into these zones. The service was often delivered personally by travelling operators with the assistance of local communities in spaces such as village or school halls not constructed for film exhibition. Localised exhibition projection in spaces shared by the operators, projector and audience, generated a different kind of cinema-going experience which is reflected in the depth of feeling and stories attached to remembering it. The current international turn in film history towards other cinemas underlines the shifting geography of enquiries into where and what cinema has been. Given the geography of Scotland, the history of the Film Guild adds a distinctive contribution to this research. The research will look at the operations of the Guild in terms of local community reaction (popular memory), schools, churches and third sector institutions) the local authorities, and the Scottish Office (including the Scottish Education Department, the Home and Health Department and the Highlands and Islands Development Board). It will combine archival, oral and creative research, building a historical record of rural cinema-going through a series of case studies. The project will be promoted in local media prior to each study. National and local archival research will investigate how the organisation provided and managed its cinema service. The National Archives of Scotland will provide records of programming, distribution and exhibition, promotion, revenue, attendance and audience feedback. Oral history enables the past experiences of residents and Guild operatives to be added to the historical record. A pilot study of the Orkney rural cinema scheme confirmed the importance of the operators in guaranteeing programmes, the effects of improvised exhibition demanded by the variable spaces that accommodated the cinema and a preference for programmes containing local content. A network of contacts has also been accumulated in response to project publicity. The volume of respondents demonstrates the importance of carrying out the study while it is possible to make this audience this cinema part of our cultural history. The PI Dr. Ian Goode has researched and published on rural cinema exhibition and will be supported by a research assistant specializing in oral history. Ian is part of a leading research strand concerned with 'other' cinemas and early cinema in Scotland. He has expertise in Scottish Film and Television and post-war cinema culture. The CI Dr. Sarah Neely specialises in Scottish Cinema, the Orkney based director Margaret Tait, and archival research. Neely has a background in facilitating creative writing. The CI Professor Callum Brown is a leading historian of religion and society in the west, with expertise in Scotland in the 19th and 20th centuries, and with extensive experience in oral history.