The Older People for Older People (O4O) Project: Creating Services, Improving Health and Challenging Perceptions

Submitting Institutions

Robert Gordon University,
University of the Highlands & Islands

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type


Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services
Studies In Human Society: Policy and Administration, Sociology

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Summary of the impact

The O4O action research project generated positive impacts for older people living in some of Europe's most remote and rural areas. It helped to shift perceptions of older people as a burden on society and towards recognition of the value they can bring to their communities as well as their potential to be involved in services design and delivery. The project underpinned the development of several older people's services that have generated employment opportunities and health/wellbeing improvement. The project challenged some of the assumptions in social enterprise/co-production policy and helped to identify the types of support that older people, and rural communities more widely, may need in order to develop their own service delivery organisations. O4O was recognised by the European Commission (EC) for its contribution to addressing the challenge of demographic change and supporting active aging.

Underpinning research

O4O was led by Prof. Jane Farmer at the Centre for Rural Health (University of the Highlands and Islands — UHI) from January 2007 to September 2010 (and Kate Stephen, project manager at UHI, from September 2010 - December 2010). The project built on Prof. Farmer's research on rural ageing, particularly the Our Life as Elderly project. Funded by the EU Northern Periphery Programme (NPP), the project was international in scope with Prof. Farmer co-ordinating work across Scotland, Northern Ireland, Greenland, Finland and Sweden. There were several interconnected elements to the research:

  • Participatory Action Research: More than 500 community members, across five countries, were supported to design, develop and run their own organisations to deliver services with, and for, rural older people [5].
  • Context Mapping: Information was systematically collected from each partner country on the conducive factors and barriers to social enterprise creation. This work was led by Dr. Sarah Skerratt (Scottish Agricultural College) with support from Dr. Sarah-Anne Munoz (Research Fellow at UHI from June 2009 - present) [1], [5].
  • Understanding Older People's Participation Behaviours: A large-scale survey of 1,500 older people in the Highland region (Scotland) allowed us to understand how older people currently participate in community activities as well as some of the factors that stifle their participation. Interviews were carried out with 27 older people in Highland to understand the impacts of involvement in O4O-type social enterprise development. This work was led by Prof. Farmer with support from UHI research staff [2], [3].
  • Analysis of the Process of O4O Social Enterprise Creation: Project Managers' diaries and interviews (carried out by Dr. Skerratt) were analysed (by Dr. Sarah-Anne Munoz) in order to identify the skills and resources required to develop O4O organisations [1], [4].

We found that it is possible to develop O4O initiatives that generate positive impacts, but the process of developing community social enterprises is organic, complex and susceptible to breaking down at numerous stages. Community members were not always willing to get involved in service delivery development [1], [4], [5].

Benefits of O4O creation included: health and wellbeing benefits for individuals; the potential to reach those `isolated' from informal networking and helping; and a harnessing of latent community skills. Challenges included: rural citizens becoming overburdened with voluntary effort; bureaucracy challenging citizens' commitment; and people remaining excluded from community dialogue [1], [5].

The research identified a set of skills and resources required by rural communities in order to create O4O social enterprises. These included: the ability to identify unmet need; catalysing the identification of needs into action; development of relationships with service users and commissioners and the ability to translate existing informal helping structures into more `formal' social enterprise [1], [4].

In addition, the context mapping produced an understanding of different types of social enterprise in Northern Europe — identifying a Nordic and a Celtic model [1], [5]. Our survey showed very little latent capacity for service co-production within the remote and rural population in Highland [2], [5]. Our interviews stressed that older people did feel health and well-being benefits from `getting involved' but this was not their main motivation for taking part, and it cannot be assumed that co-production will be a positive experience (particularly for those older people already involved in other community activities or informal helping practices) [1], [2], [3].

In summary, O4O produced important new knowledge about the reality of services co-production, particularly for older people's services, within remote and rural areas [1], [5]. The research produced a variety of outputs including a final report with case studies of our social enterprises [5]; a toolkit with guidance for communities to create their own O4O social enterprise [6]; a series of briefings for policy-makers [5]; 132 conference papers and presentations [A]; peer reviewed papers [2], [3], a book chapter [4] and an edited book [1].

References to the research

[1] Farmer, J., Hill, C., Munoz, S., eds. (2012) Socially Enterprising Communities: Service Co-Production in Rural Areas' (Boston: Edward Elgar)

[2] Farmer, J., Munoz, S., Steinerowski, A., Bradley, S., (2011) `Participation and older people's wellbeing in remote and rural Scotland', in Le, Q., ed., Health and Wellbeing: a Social and Cultural Perspective, (New York: Nova)

[3] Steinerowski, A., Bradley, S., Munoz, S., Farmer, J., Fielding, S., (2011) `Participation for Health and Wellbeing: factors associated with older people's participation in remote and rural communities', in Angus, S., Boutsioli, Z., Health Studies: Economic, Management and Policy, (Athens: Athens Institute for Education and Research), pp. 179 - 192

[4] Muñoz, S., Steinerowski, A., Farmer, J., Stephen, K., (2011) `Social enterprise as a response to the needs of ageing rural populations', Journal of Social Management, 9 (2), pp. 23 - 44

[5] Older People for Older People (O4O) Final Report,

[6] Older People for Older People (O4O) Community Toolkit,

Details of the impact

Europe's ageing population is often cited as placing a `burden' on society and the public purse. It is in some of our most remote and rural areas that populations are ageing most quickly — in the same areas service delivery is particularly challenging. Highland, for example, has seen a 32% rise in residents over 80 and 22% rise in those aged between 65 and 79 over the last decade. Policy has suggested the need for innovative service delivery solutions. O4O sought to find ways of tackling this by involving rural older people in creating their own solutions to the challenges of ageing and rural life.

We aimed to test policy rhetoric about the role of individuals and communities in accepting responsibility for their own care and the changing role of public services from top-down delivery to co-production. We helped answer questions such as: if communities are to do more, how do they go about it? Do all communities have the capacity to do this? What are the implications for individuals and communities of taking on the responsibility of developing and running services? [1], [5]. The positive impacts from the O4O project research have manifested in several ways:

Services created: O4O worked with 21 rural communities, ranging from populations of around 300 to more than 3,000, across the Northern Periphery between 2007 and 2010. In 15 communities, an older person's service was successfully established [A]. Several social enterprises were developed with the support of the O4O researchers and continue to deliver services to, and with, older people in rural areas. In Scotland, this comprises Community Care Assynt (CCA) which was established in 2010 as a community interest company to run services for older people in the Lochinver community [B] and Transport for Tongue, Melness and Skerray (T4T) created in 2009 which runs a dial-a-ride and lift sharing scheme [C]. These services created 6 part-time jobs within the lifetime of the O4O project [A]. In Sweden, a village meeting place and handyman service also created employment — there establishment was driven by three "well known" older people within the village, one of whom become the project manager [A]. Other services include: intergenerational IT courses (Sweden); lunch club and restaurant (Northern Ireland); a meeting centre (Finland); fitness groups (Greenland); radio programmes (Northern Ireland); home visiting service (Greenland) and an oral history/dvd project (Scotland) [A].

Health and quality of life improved: the ageing population brings a considerable load of chronic illness and complex morbities, combined with wellbeing problems linked to loneliness and exclusion due to lack of access. O4O addressed these public health issues by providing an intervention to keep older people healthy at home in 15 rural communities and a model that can be applied in other rural communities [A], [H]. Participants in the project reported positive health and wellbeing benefits from taking part, including: improved balance; extended social networks; mental stimulation; improved mood; raised spirit and increased sense of worth; increased sense of belonging and sense of place; revival in interest and preservation of traditional knowledge and skills [A]. The O4O services created by the project have the delivery of health and wellbeing benefits to rural older people as key aims. CCA, for example, has developed the Assynt Centre as a community care hub, offering a range of opportunities for social interaction, peer support and the development of social networks in the Lochinver area [A], [B]. A video produced by the EC on the O4O project, highlights the benefits as experienced by residents of the Highland village of Tongue where older people developed their own transport system to make a difference to the lives of other older people in the community. As the video shows, service users such as Georgina, said they no longer felt `beholden' to friends and neighbours for transport. This was perceived to benefit individual's wellbeing, not least by combating isolation [C].

Perceptions changed: O4O has helped change perceptions by showing the capacity of older people to take part in service delivery [A]. O4O built entrepreneurial and economic capacity in a group (rural older people) generally perceived to be less innovative and dynamic — thereby contributing to a changing ethos in society towards older people as a positive economic force in their own right with their own needs for goods and services and increasingly their own skills to build enterprises (social and commercial) to meet those needs [E]. Our work has been highlighted in this context by, for example, Euro-Health-Net [I], SCVO [I] and SCPHRP [H]. At project end in 2010 there had been 5,706 visitors to the project website with 13,250 copies of our materials distributed or downloaded [A].

Policy challenged, tested and influenced: O4O research has helped to disseminate knowledge on how older people can be supported to take a greater role in the development and delivery of services. CRH researchers were invited to contribute knowledge from O4O to regional and national development of policy (Highland Council, NHS Highland, Joint Improvement Team 2009 - 2011) on the future care of older people and the involvement of older people in meeting their own future service needs [A]. This has led to, for example, the creation of community development workers for older people posts within the Highland Council region in 2010 [H] and the innovative approach suggested by O4O highlighted in a Scottish Government publication [F]. Public sector bodies have also disseminated O4O materials in order to train (Northern Ireland) or encourage (Highland; Moray) communities to develop O4O social enterprises [A]. In one area (Argyll and Bute) further work was commissioned in 2012 to involve older people in developing home care service solutions. The work of O4O has been taken up by policy makers and voluntary groups in many European countries — as winner of a 2012 RegioStars award (Inclusive Growth: Strategies, Initiatives or Projects Addressing the Challenge of Demographic Change and Supporting Active Aging) the O4O concept has been widely disseminated throughout Europe as an example of best practice for rural areas [C], [D], [E], [I] and over 100 invited presentations delivered on O4O [A].

Sources to corroborate the impact

[A] Northern Periphery Progamme Final Administrative Report,

[B] Community Care Assynt:

[C] EC RegioStars video demonstrating impact of T4T:; and Video produced by the EU highlighting benefits of O4O, particularly in the Highland community of Tongue:

[D] O4O as winner of RegioStars:

[E] O4O case study by the Glasgow Centre for Population Health (for the Scottish Government): ALLER.pdf

[F] Scottish Government Publication:

[G] O4O Presented at public meeting on future of older people's services:

[H] SCPHRP work on wellbeing in later life:,

[I] O4O impacts highlighted by SCVO: and; and Euro-Health-Net:

[J] Correspondence from Highland Council: Two named individuals