The Centre’s Beacon Projects aspire to exemplify the ways in which the Centre aims to create and sustain cultures and environments of health through transdisciplinary engaged research.
Understanding how transformative community engagement creates the conditions for health
Professor Katrina Wyatt
Dr Robin Durie
Dr Felicity Thomas
Dr Amy Jones
This project will explore whether and how transformative engagement can lead to better health in economically disadvantaged neighbourhoods. Working with C2 partnerships, this research will also respond to the C2 partnerships’ own aim to explore ways of developing regional delivery mechanisms for C2 and develop an evidence base for this new approach.
Non-communicable diseases represent a global public health challenge, and are a driver of health inequalities. Yet many programmes aimed at improving the health of the population inadvertently exacerbate rather than ameliorate health inequalities. Connecting Communities [C2] is a learning programme and implementation framework that seeks to create the conditions for health and wellbeing in economically disadvantaged communities. C2 was initially designed and developed by researchers and healthcare practitioners and refined in partnership with community residents and service providers (including housing, health, the police, fire services, housing and local government). The C2 approach responds to the senses of isolation, fragmentation and abandonment experienced by people in very low income communities, and seeks to alter the nature and quality of relations within communities, as well as between communities and service-providers, in order to create the conditions for potentially transformational change. Complexity theory is the underpinning theoretical framework for the C2.
Unlike most traditional public health programmes, C2 does not start with a pre-identified problem and a predetermined set of activities to address the problem. Rather, local ‘problems’ affecting health are co-identified through extensive engagement with communities, and the partnerships which are created on the basis of this process support emergent and transformative outcomes. (Appendix 1 shows the C2 framework which centres on understanding the social and cultural context of people’s lives to identify barriers to health). It can therefore be argued that the engagement processes within C2 constitute the intervention, and the emergent partnerships between residents and service providers are a sustainable means of delivering services in response to local issues. For example, a housing renovation programme led to increases in educational attainment and employment in the area. A 70% reduction in children on the at risk register was reported and a co-created police response to antisocial youth behaviour (involving dance workshops with young people) resulted in very large reductions in truancy and improved health outcomes including a 25% reduction in asthma rates in its first two years. Both partnerships are still ongoing. There are over 20 C2 partnerships across the UK and five partnerships in England have expressed the desire to create regional hubs to deliver C2 in their locality.
The project brings together the C2 programme and partnerships with an engaged, transdisciplinary, research approach to understanding how altering the nature and qualities of relations can support health and well-being. Working with the C2 partnerships, two further neighbourhoods that wish to implement the C2 approach will be identified. [Initial discussions with C2 partnerships suggest that these will be in Stoke-on Trent and Thanet]. With the existing C2 partnership in each site we will identify, and provide support for, community-based researchers to work in these neighbourhoods to capture qualitative and quantitative evidence of connectivity and its relation to health and wellbeing. Using a combination of ethnographic and a community-informed, co-created, social network mapping approach we will seek to understand how the nature of relations changes during the C2 implementation process and whether this is associated with a change in wellbeing.
Engaged research approach: A repeated theme expressed by communities that have suffered social and economic decline is that of loss – loss of community spirit, loss of jobs, loss of local services, and loss of community spaces. Similarly, residents talk of feeling isolated from other residents, and abandoned by service providers. Loss and abandonment serve as key indicators of communities in decline, of communities suffering from “ill-health”. It is therefore striking that publics that have been engaged in academic research frequently talk of being abandoned by researchers when periods of funding come to an end, of feeling a sense of loss after being left behind by “drive-by” academics. A major objective of this project will be to build an authentic community-led approach, enabling communities to come to the fore in the research in order to co-identify issues and questions specific to their own community and to co-create possible solutions with service providers. Furthermore this will support the creation of an evidence base that the Partnerships can use to demonstrate what the C2 approach has transformed, as well as how and why these changes have come about.
Towards a framework of transferability: A further key challenge facing engaged research initiatives is that the very conditions for their potential success – namely, the development of strong local relations alongside the co-creation of a site-specific receptive context for the research collaboration – appear to militate against the possibility of translating successful engaged research initiatives to other sites. Indeed, standard models of evidence and evaluation aimed at supporting transferability and scalability appear to depend on the bracketing of context and local relations. This proposed research will develop a radically different set of principles and practices for translation and transfer, principles which embody the delivery of the work in specific sites and which are informed by the theoretical grounding of the work as a whole. For this work, the conditions of transferability are constituted by the narratives that the communities develop about their own experiences of change, by the direct experiences of the local settings which C2 provides, and which have been identified as the key for the development of the new regional learning hubs, and by the trust that is founded in collaborating with communities that have “done it for themselves”.
Transforming engagement: This project aims to become a beacon for “transforming engagement” in two main ways. First, by embodying the ethos and practices of engaged research, it will seek to show whether and how community engagement can itself be healthful. The participatory approach to collecting narratives and representing relationality within the neighbourhoods will enable us to demonstrate how engagement creates the conditions for community connectivity, and how community connectivity is in turn a condition for health. Second, the work will show how research projects can be genuinely co-designed and co-delivered by communities in partnership with academics. In particular, this project is responding to a community-identified vision of work that is being led and delivered within new neighbourhoods by the C2 partnerships. This is a radically new model of working, and it is founded in our learning from C2 that the conditions for transformative change for health are created through community engagement led in partnership with communities themselves