Title: The impact on health inequalities of approaches to community engagement in the New Deal for Communities regeneration initiative. A mixed methods evaluation
Funder: Department of Health (England)

Abstract: Design: The revised design and timetable for the research is shown on the flow chart submitted with this application. There are now three linked work packages (WP) organised as follows. Work package 1 consists of three stages: stage 1 developing preliminary typology based on analysis of qualitative and quantitative secondary data; months 1-6; stage 2 collecting new data from 10 sites months 7-14; and stage 3 revising and testing the typology months 15 - 18. Work package 2: economic evaluation months 1 – 24. Work package 3: statistical evaluation of impact months 16-24. The study has prospective and retrospective elements. It employs mixed methods utilising existing and new data to evaluate the effectiveness and cost effectiveness of different approaches to community engagement (CE) adopted by 39 New Deal for Communities (NDC) programmes. Target population: residents of 39 NDC areas (29 in the 10% most deprived English wards in 1999/2000). Populations range 5300 - 23800; younger than national average; higher proportions of lone parent couples without dependent children and H/H with many adults. Some have few BME residents: in 8 they form 50% of the population. Intervention: CE activities initially grouped into four types: inclusive strategic decision making (e.g. resident members of boards) community control of services/programmes; community capacity building; and community liaison. Outcomes and follow up: Duration of follow-up 10 years (1999/00 to 2010/11). Outcome data for residents of NDC areas and comparator area from two existing data sets generated by the National NDC Evaluation: (1) longitudinal MORI surveys (4 waves 2002/4/6/8) give measures of knowledge of/ involvement in NDC perceptions of area sense of community general and mental health; (2) unique post-coded administrative data on e.g. worklessness educational attainment mortality low birthweight crime. The study will also access secondary data on structures processes perceived influence impacts and costs of NDC CE activities from National NDC Evaluation case studies and also use data from the Health Survey for England. Additionally we will collect new data through document analysis and semi-structured face to face interviews in a sample of 10 NDC areas (25% of all NDC areas) purposively sampled to maximise diversity in terms of populations area existing information about CE and NDC programme outcomes identified by the National Evaluation Team. Finally we will undertake telephone interviews with key informants at as many of the 39 NDC areas as possible to collect information on major ‘in-kind’ costs of CE. Sample size: Secondary data sources: Internal comparisons are based on differences between 39 NDC areas in terms of identifying contrasting CE approaches. The existing MORI surveys yielded data on over 10000 NDC residents cross-sectionally and around 4-8000 longitudinally between 2 waves. Available sample size depends on the outcome of interest and survey waves used but experience shows our planned analyses are feasible. Routine datasets contain ecological data on around ¾ million people. The new research in 10 NDC sites will involve semi-structured interviews with a purposive sample of five key informants at each site - three residents and two managers - giving 50 interviews in total. Planned analyses: Work package 1.1 will involve the development of a preliminary typology of CE approaches using secondary data sources. During WP 1.2 the new documents identified during fieldwork in the diversity sample of 10 NDC sites will be subjected to a content analysis informed by themes identified in the development of the preliminary typology in Stage 1. Interviews will be tape recorded partially transcribed and analysed thematically. During WP1.3 the typology of CE approaches will be refined on the basis of the analysis of data from WP1.2 and tested with key informants at NDC sites as possible. Work package 2 will consist of the exploration of cost effectiveness of different CE approaches using results from the impact analysis and utilising costs data from secondary sources and the new fieldwork. WP 1.3 will involve the statistical analysis of impact. It will provide detailed analyses of the social and health outcomes of the NDC interventions and how these relate to types of community engagement. To achieve this the CE typology and specific variables capturing elements of CE will be linked to various data sources. We aim to test the following sub-hypotheses: H1: Type of CE will be associated with social and health outcomes among residents engaged in NDC activities. H2: Type of CE will be associated with changes in health and the social determinants of health over time in the whole NDC population: H3: Some types of CE are effective in reducing health inequalities Project timetables: 24 months from 1/10/11 to 30/9/13: Work package 1.1 developing preliminary typology months 1-6; WP 1.2 collecting new data from 10 sites months 7-14; and WP1.3 revising and testing the typology months 15 - 18. Work package 2: economic evaluation months 1 – 24. Work package 3: statistical evaluation of impact months 16-24. Synthesis and writing up: 22-24.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE