Understanding healthcare practices in superdiverse neighbourhoods and developing the concept of welfare bricolage: Protocol of a cross-national mixed-methods study.

BACKGROUND: Diversity in Europe has both increased and become more complex posing challenges to both national and local welfare state regimes. Evidence indicates specific barriers for migrant, faith and minority ethnic groups when accessing healthcare. However, previous studies of health in diverse cities in European countries have mainly adopted an ethno-national focus. Taking into account the new complexity of diversity within cities, a deeper and multi-faceted understanding of everyday health practices in superdiverse contexts is needed to support appropriate healthcare provision. METHODS/DESIGN: This protocol describes a mixed method study investigating how residents in superdiverse neighbourhoods access healthcare. The study will include participant observation and qualitative interviewing as well as a standardised health survey and will be carried out in eight superdiverse neighbourhoods - with varying deprivations levels and trajectories of change - in four European countries (Germany, Portugal, Sweden and UK). In each neighbourhood, trained polylingual community researchers together with university researchers will map formal and informal provision and infrastructures supportive to health and healthcare. In-depth interviews with residents and healthcare providers in each country will investigate local health-supportive practices. Thematic analysis will be used to identify different types of help-seeking behaviours and support structures across neighbourhoods and countries. Using categories identified from analyses of interview material, a health survey will be set up investigating determinants of access to healthcare. Complex models, such as structural equation modelling, will be applied to analyse commonalities and differences between population groups, neighbourhoods and countries. DISCUSSION: This study offers the potential to contribute to a deeper understanding of how residents in superdiverse neighbourhoods deal with health and healthcare in everyday practices. The findings will inform governmental authorities, formal and informal healthcare providers how to further refine health services and how to achieve equitable access in diverse population groups.

Access to healthcare in superdiverse neighbourhoods.

To date little attention has been focused on how the differing features of 'superdiverse' neighbourhoods shape residents' access to healthcare services. Through utilising a cross-national mixed-methods approach, the paper highlights how defining features of superdiverse neighbourhoods - 'newness', 'novelty' and 'diversity' - influence a number of neighbourhood 'domains' and 'rules of access' that regulate access to healthcare. Issues of uncertainty, affordability, compliance, transnationalism and the diversity of community and local sociability are identified as being particularly significant, but which may vary in importance according to the nationality, ethnicity and / or religion of particular individuals.

Are We All Agreed? Consensual Methods and the 'Necessities of Life' in the UK Today.

In recent decades, consensual approaches to poverty measurement have been widely adopted in large-scale survey research both in the UK and internationally. However, while ascertaining the extent of public agreement on the 'necessities of life' has been central to this approach, long-standing critiques have questioned the nature of public consensus on poverty derived using survey methods. By drawing on new primary research preparatory to the 2012 UK Poverty and Social Exclusion Survey, we consider the contribution of qualitative methods in understanding public views on necessities and discuss their implications for survey-based poverty measurement. Our findings raise some important conceptual and measurement issues for consensual poverty measures within large-scale social surveys. Firstly, our research suggests that public understandings of the term 'necessity' are diverse and may not always be consistent with researchers' interpretations or with wider usage of this term within consensual poverty measurement. Secondly, a better understanding of the considerations which inform survey respondents' deliberations is needed. Thirdly, our findings have important implications for how we should interpret the concept of 'consensus' within the context of consensual poverty surveys, and emphasise the need for the application of more deliberative methods in determining public views on the 'necessities of life'.