Background Smart Capacitating Investments (SCI) have been proposed as a means of mobilizing extra public and private investments in health promotion and disease prevention, but the concept needs clarification and development. Aim To develop the concept SCI and explore available and emerging SCI models that could generate additional resources for health promotion and prevention. Methods i) a rapid scoping review to explore existing examples of innovative investment in health promotion and disease prevention, ii) horizon scanning of recent/emerging examples of innovative investment models via expert interviews and web searches, and iii) a realist-informed synthesis of literature and interview-results to investigate investor motivations, barriers, and enablers for different forms of SCI. Results We present a definition of SCI that stresses these unconventional investments are either financial or non-financial, that they are made by reallocating and pooling public funds within the health sector or by involving other non-health public sectors, private not-for-profit or for-profit social impact investors. SCI models aim to sustainably enhance individual and community capacity for healthier behaviors, or to address determinants of health. We describe the broad range and nature of SCI via a classification and typology of SCI models. Social Impact Bonds were found to be the most frequently applied model across all levels of prevention. For successful implementation of blended SCI models by public–private partnerships, significant government involvement was important. Conclusion SCIs are diverse and novel, and they have potential to bring about change, particularly if backed by government to attract private capital and ensure rigorous evaluation.

Multidisciplinary collaboration is key to strengthening the evidence base for multifaceted illness prevention interventions. We bring together health economics and behavioral science to explore the well-being benefits and social cost–benefit of volunteer gardening at an accredited botanic garden, Wales, UK. A health economics-informed social return on investment (SROI) evaluation was combined with the assessment of volunteers’ basic psychological needs (autonomy, competence, and relatedness), connection to nature, and their interrelatedness in this innovative nature-based intervention study. Pre- and post-volunteering outcome data were collected using the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS), the ICEpop CAPability measure for Adults (ICECAP-A), the 12-item diary version of the Basic Psychological Need Satisfaction and Frustration Scale (BPNSNF), the Nature Connection Index (NCI), and a bespoke Client Service Receipt Inventory (CSRI). Results indicate that volunteer gardening can provide well-being benefits to participants and cost savings to the NHS. The well-being benefits observed were estimated to generate social value in the range of GBP 4.02 to GBP 5.43 for every GBP 1 invested. This study contributes to the evidence base that simple nature-based interventions such as volunteer gardening could offer low-cost supportive environments that deliver significant well-being benefits and associated social value to local communities, including a reduced burden on overstretched local healthcare services.

Background
The ‘long shadow’ of childhood bullying can extend beyond immediate adverse mental health and educational outcomes well into adulthood, with associated long-term health and social care costs. Reducing bullying is therefore a public health priority. KiVa, a school-based anti-bullying programme, is effective in reducing bullying in schools in Finland and is currently being tested in the UK through the large-scale Stand Together trial. Methods
The Stand Together trial is a two-arm, pragmatic multicentre cluster randomised controlled trial (RCT) to test the effectiveness and cost-effectiveness of KiVa in reducing bullying in UK primary schools compared to usual practice over one academic year. The trial is targeting approximately 13,000 7- to 11-year-olds in 116 primary schools across England and Wales, including North Wales, the West Midlands, South East- and South West England. Usual practice is defined as the delivery of the Personal and Social Education (PSE) curriculum in Wales and the Personal, Social, Health and Economic (PSHE) Education in England. To assess cost-effectiveness, we are conducting a cost-utility analysis and wider cost-consequence analysis from a school and societal perspective. Pupil self-reported health-related quality of life (CHU9D) is the primary outcome to enable the calculation of quality-adjusted life years (QALYs) in an Incremental Cost Effectiveness Ratio (ICER). The cost-consequence analysis will consider other outcomes such as pupil self-reported bullying-victimisation, pupil absence and bullying-related service use, teacher wellbeing and the frequency of parent-school meetings regarding bullying. Cost calculations will include the time and resources required to implement KiVa in schools versus usual practice, including the cost of resources and training. We will undertake sensitivity analysis to explore the impact of assumptions about dose of intervention, adherence, and costs of delivery. Our analyses will provide the first large-scale RCT-based evidence of the cost-effectiveness of KiVa in UK primary schools.