"You Go There and You are Welcomed and People do not Judge": A Reflexive Thematic Analysis of Service Providers' and Users' Views of Brief Health and Wellbeing Conversations within the Third and Social Economy Sector

Brief health and wellbeing conversations within the Third and Social Economy (TSE) sector (groups or organisations operating independently to family and government with social justice as the primary aim) could help to reduce health inequalities through increased access to disadvantaged populations. This study aimed to explore the acceptability of health and wellbeing conversations such as within the TSE, including their existence without specific training. A qualitative design was adopted, utilising semistructured, one-to-one interviews. Service providers (n = 15) and users (n = 5) across a variety of TSE settings including charities and religious settings were interviewed, most of whom had not received no specific training in initiating and engaging in health and wellbeing conversations. Reflexive thematic analysis was applied using Nvivo. Five themes were identified; TSE as an ecosystem of empowerment, an existing community-initiated style of health and wellbeing conversations, readiness to engage in brief health and wellbeing conversations, capabilities of TSE as determined by external factors, and apprehension towards health and wellbeing conversations. Generally, the safe and empowering TSE environment naturally fostered health and wellbeing conversations, mostly initiated by service users. The TSE shows a readiness to conduct health and wellbeing conversations through existing infrastructure, partnerships, expertise, and an ambition for social justice. Barriers include fear of worsening the situation such as damaging strong and trusting relationships with service users, safeguarding concerns, and the instability and uncertainty of funding within the TSE. Relevant recommendations in light of these findings are made, including that the TSE is appropriate for the conduct of health and wellbeing conversations, and funding would provide cost efficiencies for its delivery at scale. Specific training within the TSE should focus on actively initiating health and wellbeing conversations and addressing fears of adverse consequences.