Complementarity of individual-level and community-level health promotion programmes: \nA longitudinal and qualitative study of empowerment
Bibliographic record
Abstract
Health inequalities are the result of social inequalities and a major concern in the UK. In 1986 the Ottawa Charter for Health Promotion committed to tackling such health inequalities and defined health promotion as ‘the process of enabling people to increase control over, and to improve, their health’, with the concept of empowerment at the centre. Health promotion approaches can be broadly categorised into top-down and bottom-up programmes. Tensions between these exist and the value of a balanced approach has been recognised. However, it is not well understood if and how participants of programmes that take such different approaches experience empowerment and, if they could complement one another. \nThis research was set in Stoke-on-Trent, a city with considerable health challenges and inequalities. Two ‘real world’ health promotion programmes were considered: (i) The Lifestyle Service (LS), a top-down individual-level programme; and (ii) My Community Matters (MCM), a bottom-up, community-level programme. Each was studied using longitudinal qualitative methods. Baseline interviews (n=23, LS; n=28, MCM) were analysed using thematic analysis. At one year, follow-up interviews were analysed using comparative analysis and following constructivist grounded theory (n=13, LS; n=17, MCM). \nFor the LS, the thematic analysis revealed three master themes at baseline (past experiences, expectations, and barriers), and a model with three categories at follow-up (identification, planning, and action). The LS was primarily experienced with a providing role similar to person-centred approaches. For MCM, the thematic analysis revealed two master themes at baseline (community deterioration and perspectives towards community improvement), and at follow-up a model with four categories (power influences, community deciding, acting, and consequences). This programme was experienced with a providing role by ‘disengaged’ residents, but with a role of enabling action by ‘engaged’ residents. \nThis provides novel insight into participant experiences of empowerment through individual- and community-level health programmes with recommendations of how such approaches can better collaborate and complement one another as part of an overall effort to improve health and reduce health inequalities.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.007 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".