City Research Online

Abstract

Background: Community development is an approach that is centred in work with communities to empower them and enable them to identify and realise their community assets and take action on their perceived needs. Previous research has shown that community development approaches can contribute to the reduction of health inequalities. Yet, evidence of long-term investment in community development programmes is scarce. Therefore, there needs to be an understanding of how community development can be sustainably implemented so the approach can realise its full potential. This thesis aims to explore the factors which influence the sustainable implementation of community development approaches within public health systems.

Methods: A critical realist approach and qualitative research methods were adopted to conduct this research, informed by a scoping review conducted prior to the primary empirical work. The primary empirical work included two studies. First, a study interviewing experts in community development (N=13) on their experiences of sustainable implementation of community development approaches within various contexts was conducted. Second, a case study of one English local authority’s experience of moving towards sustainable implementation of community development approaches, was also undertaken in two parts focused on: (i) the scaling up a community development programme; and (ii) the embedding of co-production principles (which were a key part of the community development programme) across the local health and care system. The first part of the case study conducted interviews with stakeholders (N=14) in the People, Health & Communities Programme (PHC) and their experience of the scaling up of the programme within the borough. The second part of the case study conducted semi-structured interviews with stakeholders (N=5) in the embedding of co-production principles (one element of the PHC programme) through the local health and care partnership, as well as non-participant observation at key meetings and events in the embedding process (N=19). All data were analysed using framework analysis guided by the Consolidated Framework for Implementation Research (CFIR).

Findings: This research found that the factors which influence the sustainable implementation of community development approaches related to the characteristics of community development itself, the wider political and social context, the local public health system, individual leaders and the process of trying to sustainably implement community development. However, key themes identified reflected the complex interplay between all of these levels. Many local authorities and primary care settings have top-down paternalistic cultures which do not support bottom-up, community development ways of working; while community and voluntary organisations, are more often accepting of power sharing with communities and service users. Neoliberalism and insecure investment were also core themes running throughout the findings of this thesis. It was found that due to centralised nature of the English public health system, insecure investment, currently linked to the prolonged period of Government imposed ‘austerity’, and the need to show strong early outcomes (‘quick fixes’) to gain investment, creates a challenge for the sustainable implementation of community development within public health systems. This research was conducted within the COVID-19 pandemic, and many participants felt that the pandemic had drawn attention to the benefits of community development approaches. It was believed this in turn would support the sustainable implementation of the approach. However, there was also evidence that the pandemic was related to a lack of investment in community development as exemplified by the withdrawal of investment in the PHC programme that was part of the case study.

Conclusion: This research is one of few studies into the sustainable implementation of community development approaches within public health. This research has also highlighted the complexity of sustainable implementation, especially during uncertain political and financial times. Recommendations for systems wanting to sustainably implement community development include: being adaptable in approach; securing diverse sources of investment; and using experiential learning as a tool to shift organisation culture and build relationships between service providers and communities. Future research should consider ways to strengthen the evidence base for the impact of community development on reducing health inequalities.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments:	School of Health & Medical Sciences > Healthcare Services Research & Management School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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