Community Builders Realist evaluation 

The Community Builders Programme (CBP) is intended to reduce health inequalities by improving community assets to reduce disparities in social capital.  Community Builders (CBs) utilise an Asset-Based Community Development (ABCD) approach to work with local geographical communities and communities of identity that are vulnerable to health inequalities.  The CBP is a joint undertaking: CBs are employed by Four Greens Community Trust, strategic leadership is provided by Plymouth City Council and operational leadership by Four Greens Community Trust.   

Although ABCD has a strong evidence base and is recommended by NICE guidelines, it is recognised that differing local environments require that implementation must be tailored to each local authority and that the changes made are likely to be localised too.  Additionally, applying ABCD to communities of identity is novel.  Together these create a need to understand in more detail what changes CBP makes to Plymouth communities, and how, why and under what circumstances these changes are achieved.    

Aims  

This evaluation addressed the question: how, why, and under what circumstances the Community Builders Programme create what changes in local communities?  It aimed to understand how, why, for whom, and under what circumstances CBP creates change, and the extent of that change by creating and testing a Realist programme theory of describing what causes change within the CBP (mechanisms), what these changes are expected to be (outcomes), and factors that make it harder or easier for these changes to take place (contextual barriers and enablers).    

Activity  

We undertook a Realist evaluation in two stages:  

Phase 1:  

We undertook stakeholder engagement and evaluation of internal documents to develop an initial programme theory explaining how, why and under what circumstances the Community Builders Project achieves its outcomes. We co-designed the remainder of the project with Community Builders leaders and funders.    

Phase 2:  

We interviewed community builders and undertook ripple effects mapping workshops with community members.  Interview and Ripple Effect mapping data were collected and analysed retroductively to investigate the extent of change, and to test and refine the programme theory.  Following co-design with project leaders there was a particular focus on:  

• What changes are the community builders empowering?  How, why and under what circumstances are these made?  What role does ABCD have in causing these changes?  

• Exploring ‘harder to reach’ individuals: who is it harder for CBs to work with and why?  How, why and under what circumstances do CBs work to overcome these challenges?  

• Understanding ‘belonging’ and community building: what about people who belong to multiple communities, what about people who do not feel they belong to a community?  How do CBs work when people belong to multiple communities?    

• What impact does Plymouth City Council working in partnership with Four Greens facilitate in achieving the aims of the CB programme, how and why?    

Outputs  

Findings were presented to project leaders, project funders and the local care partnership, helping to demonstrate impact and to improve further implementation of community builders locally. 
 
Internal interim and final reports were shared with project leaders and project funders in May 2024 and October 2024.   
 
Methodological findings regarding the sharing of programme theory across different mental health community projects were shared at the European Network for Mental Health Service Evaluation 2024 conference.    

Next steps  

Our learnings from this project included how community organisations can contribute to improving mental health equality.  Alongside the [link] The Realist Evaluation of the Community Engagement Project this work has helped inform the design of our:  

• Mental health inclusion realist synthesis: How, why, for whom, and under what circumstances do what interventions improve inclusion in mental health services for marginalised groups?

• Successful NIHR HSDR bid application: Coastal and Rural Mental Health Realist Study (CARMHRS): what works, for whom, in what circumstances, how and why?  

• Stage 1 NIHR PgFAR bid application: Prevention and Care for Common Mental Health Problems Across the Life Course.