Abstract
ABSTRACTWe provide new empirical and methodological findings problematising evidence, evaluation and measurement when using asset-based approaches and co-production to improve health and address inequalities. The Assets Model was applied to develop and implement a co-produced methodological evaluation framework – Asset-Based Indicator Framework – measuring impacts of creative community engagement on health and inequalities. Our three-phased approach synthesised data from multiple sources over five years. Phase One identified existing health assets in Black and Minority Ethnic (BME) groups using a six-month ethnography; interviews with community organisation representatives (n=35); three BME focus groups (n=27). Phase Two identified conditions/actions for assets to be activated to maximise health for ‘Roma’ using community-based participatory action research (n=50). Phase Three turned to evaluation and indicators. The Asset-Based Indicator Framework was co-produced with self-identified Gypsies following an extensive literature review; expert interview; three participatory action-research workshops with professionals (n=20); two participatory action-research workshops with community members and professionals (n=49). Asset-based evaluation and measurement is complex due to narrow conceptualisations of evidence; epistemological and methodological incompatibilities; and lack of capacity and resources for sustained engagement. Understanding the granularity and interrelation of assets at individual, community and structural levels; identifying mechanisms through which change happens; and applying participatory and empowering methods to capture actions on assets leading to community-defined outcomes may not lead to meaningful changes without systemic change. The paper fills a clearly-defined gap addressing evaluation of community engagement within complex systems rather than clinical-medicine interventions with wide-ranging implications for international research, practice and policy.
Highlights
This paper addresses calls to ‘revitalise’ the evidence-base and progress evaluation for asset-based approaches to tackle health inequities (Rippon & South, 2017; Morgan & Ziglio, 2007, p. 7)
To identify assets and understand beliefs and behaviours from an insider view, data in Phase One were collected through a six-month ethnography, semi-structured interviews and focus groups with communities and representatives from community organisations
It is feasible for communities and practitioners to co-produce participant-led evaluation frameworks to measure impacts of asset-based approaches on health and inequalities, but this comes with several caveats
Summary
This paper addresses calls to ‘revitalise’ the evidence-base and progress evaluation for asset-based approaches to tackle health inequities (Rippon & South, 2017; Morgan & Ziglio, 2007, p. 7). This paper addresses calls to ‘revitalise’ the evidence-base and progress evaluation for asset-based approaches to tackle health inequities ANGELOVA compelling given global health challenges including widening inequalities; poverty; non-existent health systems in some nations, culturally inappropriate ones in others; and aging populations (Marmot, 2005). Solutions have included setting high-level global targets such as United Nations Millennium Development Goals, and an array of interventions – with limited evidence of success (Clegg, 2015; Smith & Eltanani, 2015). Dominant neoliberal discourses and emphasis on individual choice rather than structural drivers of inequalities are recurrently blamed (Smith, Bambra, & Hill, 2015) – themes that have fractured public health over whether we should focus on individual or communities’ needs or their strengths (assets) to improve health and reduce inequalities
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