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A settings-based approach is now well-established in health promotion, initially undertaken in conventional places like schools and workplaces, but more recently being expressed in a wider range of what Torp et al. call 'everyday' settings. In this context, libraries have emerged as another potential setting whose ubiquity and accessibility suggests that they may be particularly effective in addressing health inequalities. Drawing on a case study-the Glasgow Macmillan Cancer Information and Support Services Library project-this paper reports on the potential for seeing 'libraries as settings' and in the context of a set of associated theoretical resources, specifically scrutinizes the nature of initiative implementation. Data were drawn from multiple sources: semi-structured interviews and focus groups with strategic partners and stakeholders, operational staff, project volunteers, service users and members of the general public. Qualitative data were complemented by quantitative insights from surveys with members of the partnership, libraries staff and volunteers. Despite some concerns associated with potentially hostile cultural and financial contexts that might threaten longer term sustainability, insights suggested that in pragmatic terms, the project was attracting sizable 'footfall' and successfully addressing a range of needs. Additionally, the formal implementation processes associated with project implementation were considered to have been highly successful in embedding the model into the library culture. In summary, there is evidence that libraries have the potential to be considered as supportive settings and could act as a model for an emergent vision of what libraries do., (© The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Health services continue to be seen as significant settings for health improvement, and developments continue to be made in the nature of such work, means of optimal delivery and outcomes. This paper builds on previous work by reporting on activity in a series of sites within 'NHS Health Scotland's (NHS HS)' Health Promoting Health Service (HPHS) initiative. The objectives of the review were to: describe the achievements of HPHS sites, assess the degree of influence and embedding of the HPHS approach, review the support functions provided by 'NHS HS' and identify the challenges to implementation and sustainability. The review identified a variety of activity associated with HPHS, ranging from a topic focused/behaviour change approach to efforts to re-orientate organizational features. The role that NHS HS played in developing settings capacity was largely endorsed, and there was, despite the existence of some barriers, evidence that HPHS was being successfully embedded within health service organizational policies and procedures. In particular, the role of a national level strategic guidance document to NHS CEOs ['Chief Executive Letter (14)'] is noted as having been significant in creating a conducive context for HPHS. In this context, the paper concludes by reflecting more broadly on the current status of settings-based health improvement and suggests that on the basis of this review there should be optimism in pursuing a relatively expansive vision of health improvement in this particular setting and potentially others.

In 1996 the Health Education Board for Scotland (now NHS Health Scotland) began a process of developing a 'settings'-based framework that would inform health promotion work across Scottish health services--the Health Promoting Health Service Framework (HPHS). It took the form of a flexible guidance document, attending to the foundations of integrated and sustainable health promotion practice via specific areas like partnership work, policy development and staff health. The project has subsequently been progressed over an extended period, comprising three phases: an initial development of the resource; piloting of the framework; and a wider assessment of implementation and initial impact. This paper reports on the latter phase. Within the context of various issues pertaining to the evaluation of a 'settings' approach and based on the use of case study methodology in nine HPHS pilot sites, this paper reports on the latter 2 year phase. This involved ongoing concern for understanding intervention processes and a growing interest in intervention outcomes and the paper reports on findings in each of these domains. In relation to outcomes, some positive gains in various indicators were detected though significant problems were experienced in this aspect. More significantly, the work was able to gain insights into what we call 'necessary conditions' of implementation. We theorize a range of 'contextual' factors (e.g. responsiveness to health improvement policy agendas) and project specific 'mechanisms' (e.g. providing skilled support) and present these as a nexus of conditions required for effective implementation of health promotion practice within explanatory models. Most significantly, we stress the relative frailty of any settings implementation strategy based simply on the uncoordinated dissemination of a tool or resource.