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

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. 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. 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. 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. 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