Table 1.

Prioritised outcomes

Short-term outcomes

1. Increased confidence, Empowerment, Self-efficacy This cluster was prioritised as the most important set of intermediate outcomes to assess. The outcomes were perceived by stakeholders as a group of individual based outcomes that establish the foundation for other community and long-term outcomes to occur. Increased confidence was perceived by stakeholders as one of the key outcomes that, coupled with an increase in self-efficacy (one’s belief in their ability to achieve an outcome), leads to participants feeling empowered at an individual level. This individual empowerment can then result in improved individual mental health and wellbeing. This can also lead to a collective community empowerment that has been linked to incorporating group dynamics and utilising interactive learning [36].

2. Understanding attitudes, Voicing of opinions and raising questions This set of outcomes emphasises the ability and willingness of participants to critically think and vocalise their thoughts. These outcomes are associated with a higher retention of knowledge and an increased uptake of critical thinking skills [37].

3. Increased awareness, Increased learning and development This last pair of outcomes incorporates learning about health with an increased awareness of health, including awareness of individual health, community health and the social determinants of health. Consequently, this increase in awareness mirrors an increase in learning and development [38].

Long-term outcomes

1. Increased individual mental health and wellbeing Measuring the change in mental health and wellbeing was important to the stakeholders because it has been shown that an improvement in health can have positive effects and elicits other changes. It can also be a precursor to improved physical health which could contribute, with improved mental health, to the reduction of health inequalities [39].

2. Enhanced social capital Social capital refers to social networks and the resources that are available through these links [40]. Gaining social capital is associated with improved mental health and wellbeing and increased interaction in the community showing a sense of social cohesion (the willingness of groups/communities/societies to interact and cooperate with each other) among the individuals and the community agencies and other members. One example of enhanced social capital in HIIC is at the end of Part 1 when participants work together to research an issue in their community. In order to engage fully with the issue, participants often contact other members of the community for example, to try to keep a local park free of safety hazards such as broken glass and syringes, they may contact police to enquire if the area is patrolled at night, which then allows for the possibility for the participants to invite the community members to their presentation thus establishing social cohesion through the outreach.

3. Increased health of communities This outcome reflects the community-wide changes that come from the course with potential outputs being increased volunteering, further activity in community projects, and increased physical health. Community health can be improved by engaging participants in an intervention and using the data to shape plans for further community goals which reflects HIIC’s community-led approach [41].