Title: Common Health Assets: a mixed methods realist evaluation and economic appraisal of how community led organisations impact on the health and wellbeing of people living in deprived areas
Funder: Chief Scientist Office, Scotland

Abstract: The aim of this research is to find out how community organisations’ use of ‘assets based approaches’ improves health and wellbeing, and how that might be different in different contexts. Where we find positive effects we will examine whether those effects can be applied elsewhere (‘scaled up’), and how community organisations can find ways to survive (sustainability). _x000D_ _x000D_ Assets based approaches are about ‘doing with’ (rather than ‘doing to’) and working with communities to build on their strengths, mobilising the knowledge and skills of local people. We will study community led organisations, or ‘CLOs’, in areas that are often called ‘deprived’ - because of poverty, poor physical and social environments and lower health outcomes. CLOs work with communities to offer a range of activities, such as walking or cooking groups, language classes, and community gardens or cafes. _x000D_ _x000D_ Some studies have shown that community focused approaches can have a positive effect on health and wellbeing. However, research is limited and we know little about mobilising people as ‘health assets’, which approaches lead to which outcomes, and how different contexts might affect success. _x000D_ _x000D_ This research will result in new knowledge to address the gap in evidence. We will work with 15 CLOs based across England, Scotland and Northern Ireland. We will interview and run workshops with their staff and stakeholders, to find out what they already know about how programmes work, and what data they already have about their impact. We will measure outcomes, before and after participation, for 225 CLO participants to see how things change for people who connect with the CLOs in their communities. An economic analysis will estimate costs and compare those with benefits to participants. A panel of individuals with experience of living in our CLO communities will also be established to ensure the appropriateness and relevance of the research, and the interpretation and reporting of findings._x000D_ _x000D_ CLOs are different in different places. They are responsive to local needs, and it is unlikely that the same things work everywhere, with different people. We will use an approach called realist evaluation to develop a ‘programme theory’, of what works, for whom, in what circumstances. A range of research methods will be used to test and update the programme theory. The methods 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. _x000D_ _x000D_ Community members, people with lived experience and people working in and with CLOs are involved in each stage of the research, including study design and interpretation of findings. A PPI panel will meet at each key stage, roughly every six months. Our research team includes co-investigators from community organisations who have contributed to this proposal to ensure methods are participatory, relevant and meaningful. _x000D_ _x000D_ The findings of this project will be presented visually, in a photographic exhibition in communities and online, through social media, in policy briefings, and in academic conferences and papers.

Lay abstract: Communities are seen as part of the solution and partners in public health improvements and reducing health inequalities. Assets based approaches recognise that health and wellbeing are enhanced by individual, community and organisational assets. Research is dominated by case studies and there is a lack of large-scale, theory-driven empirical research that can be used to make more general claims about how community assets improve health and wellbeing. Few studies address generalisability, sustainability or economic appraisal. This research will address that gap._x000D_ _x000D_ Community-led organisations (CLOs) (placed based, community governed and owned) like Healthy Living Centres work with social missions that reflect the social determinants of health. CLOs vary in terms of the social needs they address and in their constitutions but can be seen as a ‘family of interventions’. They can be characterized as taking assets-based approaches, working with rather than for; mobilising people, skills, relationships, environmental and material assets, to improve wellbeing in local populations._x000D_ _x000D_ This research project is a three year multi-method, realist investigation of how, for whom and in what contexts CLOs impact on health and wellbeing. 15 CLOs will be selected in 4 areas in 3 countries: Glasgow/Lanarkshire, Belfast/Londonderry, Bournemouth and East London. As well as CLO partners who contributed to the preparation of this proposal, we will select CLOs that are diverse in terms of size, maturity, geography, population, activities, funding and other features as identified by partners and stakeholders. A panel of individuals with experience of living in our CLO communities will be established to ensure the appropriateness and relevance of the research, and the interpretation and reporting of finding._x000D_ _x000D_ Using participatory qualitative methods (stakeholder workshops; Photovoice) and building on existing theory, empirical research, existing CLO-held data and analysis of policy ecosystems, we will generate programme theory to represent how CLOs trigger particular mechanisms and outcomes for different people in different contexts. At the end of Phase 1 we will have a rich picture of CLO contexts and set of context-mechanism-outcome (CMO) configurations for testing in phase 2._x000D_ _x000D_ Phase 2 comprises a longitudinal questionnaire survey with CLO participants, quantitative analysis and economic appraisal, stakeholder workshops and participant interviews. Resource use and outcomes will be measured for 225 participants sampled across the 15 CLOs at 0, 1, 6 and 12 months. ICECAP-A is the primary outcome, the dimensions of which map well onto outcomes identified in prior research, assets theory and practice based models. Secondary measures include WEMWBS, EQ5D, SOC-13 and social isolation and loneliness (ONS). Preliminary quantitative analysis with 1-month data will be used to identify participants that are exemplars of C-O patterns for qualitative interviews to explore potential mechanisms. Q methodology will be used to further explore the nature and patterning of mechanisms. Programme theory will be refined, based on emergent data, stakeholder workshops and lived experience panels. Resources and outcomes associated with each CMO configuration will be presented in a Cost Consequence Analysis. Drawing on local CLO data, financial statements, funding sources and stakeholder interviews we will provide an analysis of scalability and sustainability

Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: GENERIC HEALTH RELEVANCE