Enacting 'community' : conceptualisations and practices of 'community' in a UK area-based, empowerment initiative

Abstract

The practice of engaging the ‘community’ has established presence in public health efforts to target inequalities. However, there remains a lack of critical consideration of how ‘community’ is conceptualised in delivering and evaluating participatory health interventions. This may contribute to the lack of conclusive evidence of the impact of 'community' engagement on health inequalities in the UK and elsewhere. This thesis explored how ‘community’ was enacted through an area-based, ‘community’ empowerment initiative in the UK, to contribute to approaches for evaluating the impacts of such interventions. Drawing on post-humanist, ontological perspectives and actor-network theory, I examined how ‘community’ was enacted through the delivery of the ‘community’ initiative in two areas. I conducted an ethnographic case study over 13 months between 2014 and 2015, and employed multiple qualitative methods to identify practices and conceptualisations constituting enactments of ‘community’. The research was conducted in parallel with a study evaluating the initiative’s impacts on determinants of health inequalities. ‘Community’ was enacted through ongoing ‘boundary work’; or, the assertion and negotiation of spatial, material and social boundaries around eligibility to contribute to and/or benefit from the initiative. Practices and values of the initiative contributed to positioning the individual as separate from the ‘collective’, and to constructions of the ‘community’ as a holistic but segmented entity. Finally, relations of disconnection – of ‘missing out’ – were identified as inherent to enactments of ‘community’ and to the process of aligning my ethnographic practice with evaluation research. These findings hold implications for theorising the pathways to improved health via collective empowerment, and processes of inclusion and exclusion in participatory initiatives. They indicate that evaluation practice must explore how the multiple ways of doing ‘community’ cut across the intervention-context divide, and consider the relevance of this for producing transferable evidence on engaging the ‘community’ to address health inequalities.