February 22, 2022
Seeking the evidence
There is a disconnect between what we intuitively know and understand about the value of community led health provision, and a compelling evidence base that would unequivocally make the case for funding this work and for it to be recognised as much more than an outlier of mainstream health and care provision. Instead, if the community provision was effectively resourced, the intolerable pressures on primary and secondary health providers would begin to ease. A major new research venture, which is bringing together all the key partners, aims to find that missing evidence base.
This research is important because policy attention on community approaches to health and wellbeing has often increased faster than the evidence base. In order to ensure good policy, we need good evidence, developed through rigorous, theory-based studies.
There is evidence starting to emerge that sustained positive health and social outcomes canonly occur when people and communities have opportunities to manage their own futures, and the skills and capabilities to be able to do so. The importance of community – community spirit, mutual aid and support – was brought home to us all during the COVID-19 pandemic.
This research will help focus attention on the importance of community topublic health generally; especially important as we rebuild, and imagine, what may be required to cope with future crises.
The CommonHealth Assets project is led by Rachel Baker, Professor of Health Economics and Director of the Yunus Centre for Social Business and Health at Glasgow Caledonian University. Rachel oversees a multi-disciplinary collaboration between researchers at GCU, Bournemouth University, Glasgow Centre for Population Health, Queens University Belfast, the University of East London and community led organisations in Scotland, England and Northern Ireland.The project is funded by the National Institute for Health Research.
Collaboration is at the heart of this research. By working alongside community-led organisations and a wide range of stakeholders and investigators from several disciplines in our research and activities, we will co-create research that is relevant, effective and user-friendly.The team includes experts on assets-based approaches, health economics, community development and realist approaches to research. Methodologically, the project combines qualitative methods, policy analysis, photovoice, Q methodology and economic evaluation.
We will work with community led organisations, or ‘CLOs’, which we define as place-based community-owned and governed organisations usually found in the ‘third’ or voluntary sectors, in areas that are often called ‘deprived’ because of poverty, poor physical and social environments and lower health outcomes. CLOs are vital to communities, and regularly offer a range of activities, such as walking or cooking groups, language classes, and community gardens or cafes.
Assets based approaches are about ‘doing with’ (rather than ‘doing to’) and working with communities to build on their strengths and mobilise the knowledge and skills of local people. Assets-based approaches also involves recognising that to do this successfully requires shifting control back into the hands of communities. They are designed to bring people in communities together to achieve positive change, focusing and mobilising their own knowledge, skills and experience, rather than viewing communities as having ‘deficits’ that need ‘fixed’.
CLOs are different in different places. Some are large, some are very small. Some are likely to have been established for a long time, while others will be fairly new. Some will betowns and cities, while others might be based in remote or rural communities. Some work with specific groups of people, while others are designed to cater for the needs of the whole community. Whatever their size or shape, they are responsive to local needs, but it is unlikely that the same approach work will exactly the same in different places, or with different groups of people.
In order to capture these different impacts, we will draw upon an approach called ‘realist evaluation’ to develop a working theory of what works, for whom, in what circumstances. A range of research methods will then be used to test and update the programme theory. The methods we will employ include stakeholder interviews, a creative method called ‘Photovoice’, analysis of policies and funding streams in different places, workshops, a card sorting method called “Q”, and a survey of users to measure costs and benefits. Each method tells us something different about the CLOs and how they work, their communities, their funding and how users feel before and after taking part.When approaches are shown to work locally, issues of scale and sustainability are important to consider, both for policy and for practice