Abstract

BackgroundArea-based initiatives that engage the community to improve health and social inequalities have an increasing presence in policy making. Despite much social science theorising around community, the operationalisation of the concept in evaluations of area-based initiatives is underexplored. Lack of evidence linking these initiatives to improving health inequalities suggests that closer examination of how community is interpreted could benefit understanding of how an initiative might affect inequalities. This study sought to explore interpretations of community in the context of one empowerment-focused, resident-led, regeneration area-based initiative in progress in England, and to contribute to the understanding of how such initiatives can be evaluated. MethodsA qualitative, ethnographic case-study was conducted in two sites participating in the initiative, one urban and one coastal. Fieldwork was done between April 1, 2014, and April 21, 2015, and involved observations of about 30 meetings and events, 40 in-depth interviews and informal conversations, and reflexive field notes from time spent in each site. Study participants were residents involved in delivering the initiative, representatives from local organisations, and others varyingly engaged with the initiative. FindingsMultiple social, material, and spatial practices were identified as constituting community in the delivery of the initiative. Negotiations of community boundaries were common among residents, emerging through articulations of different interpretations of the eligibility of people, organisations, and spaces to participate in decision making and to benefit from the initiative. Practices undertaken as part of the initiative, including delivering newsletters and setting up events and activities in local spaces, also reflected interpretations of, and engagements with, community. Finally, shifting connections with other places, people, and times, such as formal institutions and legacies of past initiatives, indicated the permeability of community boundaries. InterpretationEvaluations of area-based initiatives should attend closely to how the boundaries of the target population and context of an initiative—the community—are varyingly interpreted and constituted among different people, and in different spaces and times, and how the practices of the initiative itself contribute to these interpretations. This perspective will add depth and complexity to interpretations of how area-based initiatives have an effect on health inequalities and who might be included in and excluded from its effects. FundingThis work was supported by the National Institute for Health Research School for Public Health Research.

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