Evaluating and evidencing asset-based approaches and co-production in health inequalities: measuring the unmeasurable?

Abstract

We provide new empirical and methodological findings problematising evidence, evaluation and measurement when using asset-based approaches and co-production to improve health and address inequalities. The Assets Model was applied to develop and implement a co-produced methodological evaluation framework–Asset-Based Indicator Framework–measuring impacts of creative community engagement on health and inequalities. Our three-phased approach synthesised data from multiple sources over five years. Phase One identified existing health assets in Black and Minority Ethnic (BME) groups using a six-month ethnography; interviews with community organisation representatives (n=35); three BME focus groups (n=27). Phase Two identified conditions/actions for assets to be activated to maximise health for ‘Roma’ using community-based participatory action research (n=50). Phase Three turned to evaluation and indicators. The Asset-Based Indicator Framework was co-produced with self-identified Gypsies following an extensive literature review; expert interview; three participatory action-research workshops with professionals (n=20); two participatory action-research workshops with community members and professionals (n=49). Asset-based evaluation and measurement is complex due to narrow conceptualisations of evidence; epistemological and methodological incompatibilities; and lack of capacity and resources for sustained engagement. Understanding the granularity and interrelation of assets at individual, community and structural levels; identifying mechanisms through which change happens; and applying participatory and empowering methods to capture actions on assets leading to community-defined outcomes may not lead to meaningful changes without systemic change. The paper fills a clearly-defined gap addressing evaluation of community engagement within complex systems rather than clinical-medicine interventions with wide-ranging implications for international research, practice and policy.