Putting context centre stage: evidence from a systems evaluation of an area based empowerment initiative in England

Lois Orton,Emma Halliday,Michelle Collins,Matt Egan,Sue Lewis,Ruth Ponsford,Katie Powell,Sarah Salway,Anne Townsend,Margaret Whitehead,Jennie Popay

doi:10.1080/09581596.2016.1250868

Abstract

It is now widely accepted that context matters in evaluations of the health inequalities impact of community-based social initiatives. Systems thinking offers a lens for uncovering the dynamic relationship between such initiatives and their social contexts. However, there are very few examples that show how a systems approach can be applied in practice and what kinds of evidence are produced when this happens. In this paper, we use data from ethnographic fieldwork embedded within a multi-site mixed method evaluation to demonstrate how a systems approach can be applied in practice to evaluate the early stages of an area-based empowerment initiative – Big Local (funded by the Big Lottery Fund and delivered by Local Trust). Taking place in 150 different local areas in England and underpinned by an ethos of resident-led collective action, Big Local offers an illustration of the applicability of a systems approach to better understand the change processes that emerge as social initiatives embed and co-evolve within a series of local contexts. Findings reveal which parts of the social system are likely to be changed, by what mechanisms, and with what implications. They also raise some salient considerations for knowledge generation and methods development in public health evaluation, particularly for the evaluation of social initiatives where change does not necessarily happen in linear or predictable ways. We suggest future evaluations of such initiatives require the use of more flexible designs, encompassing qualitative approaches capable of capturing the complexity of relational systems processes, alongside more traditional quantitative methods.

Highlights

In public health evaluation, context is broadly defined as ‘the circumstances or events that form the environment within which something exists or takes place’ (Poland et al, 2006, p. 59) – i.e. a policy or initiative – and may include political, organisational, economic and social features (Blamey & Mackenzie, 2007)
We identified various aspects of social context that influenced the development of collective action within each local system
The findings presented here offer insights into how a systems approach, that foregrounds social context, can help reveal the changes and processes that might lead to enhanced collective action by communities, and how these might impact on social and health inequalities and their social determinants

Summary

Introduction

Context is broadly defined as ‘the circumstances or events that form the environment within which something exists or takes place’ (Poland et al, 2006, p. 59) – i.e. a policy or initiative – and may include political, organisational, economic and social features (Blamey & Mackenzie, 2007). Evaluations have assessed the impact of such initiatives through linear causal chains giving prominence to experimental designs using quantitative methods Such evaluation approaches may be inappropriate where initiatives are introduced into multifaceted social, economic and political environments as they leave little scope for capturing insights into the complexities of how such dynamic systems function (Diez Roux, 2011). We must study the relationships between component parts within the system, and between the whole system and the wider environment within which it sits This requires more flexible evaluation designs including the use of qualitative methods in order to track the complexities of shifting social processes (Hawe, Bond, & Butler, 2009)

Objectives

Conclusion