Community-led support in South Wales in response to the COVID-19 pandemic: a qualitative study with a systems-lens approach

BACKGROUND: During the pandemic, communities across Wales rapidly mobilised and self-organised in order to support the most vulnerable people. This study aimed to explore factors that contributed to mobilisation of community-led support, activities provided, and how these activities helped to address emerging needs. We also explored how community-led support was integrated with existing services, what worked and did not work well, and how such support could be sustained after the pandemic. METHODS: We did a qualitative study with a system-lens approach. Data were collected in two communities in South Wales (one urban and one rural) between May 12 and July 7, 2021, using purposive and snowball sampling. We conducted semi-structured, in-depth interviews by telephone and over Microsoft Teams with adults aged 18 years and older; each lasting approximately 90 min. Interviews were audio-recorded, transcribed, and analysed thematically using CAQDAS software (NVivo12). Ethics approval was received from the University of Bristol ethics committee. Written or verbal consent was obtained from each participant, before the interview started. FINDINGS: We completed 51 interviews; participants included recipients of support (n=10), volunteers (n=24), and strategic leads (n=17). Of the 51 interviewees, 31 identified as females and 20 as males. Participants perceived disruption in service provision, emerging local needs, and raised awareness of people left vulnerable by the pandemic as key drivers for community-led action. Further enabling factors included drawing on existing community resources and social capital, alongside characteristics of the volunteers (age, health, time, and skills). Participants highlighted the key role of informal community groups in responding promptly to emerging and exacerbating needs, due to ability to mobilise and adapt quickly to changing context and capacity to harness local knowledge and resources to reach those in need. This ability was crucial, especially at the early stages of the pandemic when statutory services had to restructure. Partnership working between statutory services and community groups was seen as beneficial, enabling greater reach and increased capacity to respond. Recipients of support described heavily relying on local community for help, which included practical as well as emotional support. The need to consider ongoing needs of vulnerable groups as we enter recovery from COVID-19 was highlighted, alongside the need to capture key lessons learned. INTERPRETATION: Our findings include perspectives across the system layers on how communities responded to the COVID-19 pandemic, and the importance of community action in supporting the vulnerable. Community-led action is seen as an important resilience asset and protective factor against widening health inequalities during, and in recovery from, COVID-19. FUNDING: The Health Foundation.