Pathways to mental health improvement in a community-led area-based empowerment initiative: evidence from the Big Local 'Communities in Control' study, England.

BACKGROUND: Area-based initiatives that include a focus on community empowerment are increasingly being seen as potentially an important way of improving health and reducing inequalities. However, there is little empirical evidence on the pathways between communities having more control and health outcomes. PURPOSE: To identify pathways to health improvement in a community-led area-based community empowerment initiative. METHODS: Longitudinal data on mental health, community control, area belonging, satisfaction, social cohesion and safety were collected over two time points, 6 months apart from 48 participants engaged in the Big Local programme, England. Qualitative comparative analysis (QCA) was used to explore pathways to health improvement. RESULTS: There was no clear single pathway that led to mental health improvement but positive changes in 'neighbourhood belonging' featured in 4/5 health improvement configurations. Further, where respondents experienced no improvement in key social participation/control factors, they experienced no health improvement. CONCLUSION: This study demonstrates a potential pathway between an improvement in 'neighbourhood belonging' and improved mental health outcomes in a community empowerment initiative. Increasing neighbourhood belonging could be a key target for mental health improvement interventions.

Applying qualitative comparative analysis (QCA) in public health: a case study of a health improvement service for long-term incapacity benefit recipients.

BACKGROUND: This paper explores the value of qualitative comparative analysis (QCA) in public health research using the example of a pilot case management intervention for long-term incapacity benefit recipients. It uses QCA to examine how the 'health improvement' effects of the intervention varied by individual and service characteristics. METHODS: Data for 131 participants receiving the intervention were collected over 9 months. Health improvement was measured using the EuroQual Visual Analogue Scale. Socio-demographic, health behaviour data were also collected. Data on service use was obtained from the provider's client records. Crisp set QCA was conducted to identify which individual and service characteristics were most likely to produce a health benefit after participation in the intervention. RESULTS: Health improvement was most likely amongst younger participants, men aged over 50 and those with an occupational history of skilled manual work or higher and less likely amongst older women, those with a musculoskeletal condition and those with semi- or un-skilled backgrounds. Service characteristics had no impact. CONCLUSIONS: The QCA identified potential causal pathways for health improvement from the intervention with important potential implications for health inequalities. QCA should be considered as a viable and practical method in the public health evaluation tool box.