Recently, NHS Dorset commissioned a programme of engagement to better understand how people feel about being asked a simple but important question: “How good are you at taking care of your health?” This question helps us understand an individual’s level of activation, or their knowledge, skills and confidence in managing their own health. Evidence suggests that people with higher activation often experience better health outcomes, but we wanted to explore how people felt about being asked this question and how it could best be used within care conversations. Understanding ‘When would be the best time to ask the question’? and ‘What matters most to people being asked about their care’?
What we learned went far beyond the answers to those original questions.
Focusing on the “What”, Not the “How”
When commissioning this work, we deliberately chose not to prescribe a single engagement method. Instead, we focused on the outcomes we wanted to achieve and the key questions we wanted to explore.
We worked with four community organisations that already had trusted relationships with local people. Rather than asking them all to run the same engagement activity, we gave them the flexibility to use approaches that they knew would work best for the communities they supported.
The result was a rich and diverse programme of engagement that included community drop-ins, creative writing workshops, focus groups, social prescribing conversations, online surveys, one-to-one discussions, community events and shared meals. Views were gathered from people with very different backgrounds, experiences and levels of confidence in managing their health.
As commissioners, this was a valuable lesson. When we focus on what we need to learn, rather than dictating how it should be done, we create space for innovation, creativity and stronger community-led solutions.
The Power of Trusted Relationships
One of the greatest strengths of this approach was the ability to engage through trusted people, trusted organisations and trusted places.
Far too often, engagement activities are designed around what is convenient for organisations rather than what is accessible for communities. By working with organisations that already had established relationships, conversations felt natural and meaningful. People were able to contribute in environments where they felt comfortable and confident.
This approach was particularly valuable in reaching people whose voices are often underrepresented in traditional engagement activities, including communities experiencing health inequalities and people with different experiences of accessing healthcare services.
For NHS Dorset, this reinforced an important principle: meaningful engagement is not simply about asking questions. It is about creating the conditions that enable people to share their views openly and honestly.
Building Confidence in Innovation
As a commissioner, one of the most encouraging aspects of this work was the pace and quality of delivery.
By empowering organisations to work in ways that suited their communities, engagement activities were mobilised quickly. More importantly, the findings provided valuable insights that are helping to inform local care design and workforce development.
The experience also increased our confidence in commissioning more flexible and outcome-focused approaches in the future. Innovation is not always about introducing something new. Sometimes, it is about creating the freedom for people to work differently and trusting them to find the best route to the desired outcome.
Why We Will Continue to Use This Approach
Health and care systems face increasingly complex challenges. Whether we are designing new services, implementing innovations or transforming existing pathways, it is essential that decisions are informed by the people and communities we serve.
Mixed methods engagement provides a practical way of doing this. It allows us to reach people through approaches that suit their needs, preferences and circumstances. It helps us hear a broader range of perspectives and provides richer insights than a single engagement method alone.
Most importantly, it helps ensure that innovation is shaped by lived experience, not assumptions.
Looking Ahead
We will continue to explore opportunities to commission mixed methods engagement as part of innovation, transformation and service improvement programmes. We believe this approach supports better decision-making, strengthens partnerships with communities and ultimately leads to services that work better for the people who use them.
