Asset-based approaches to promote health and reduce inequalities in neighbourhoods. A qualitative theory-based investigation of two cases

In recent years, a resurgence of interest towards asset-based approaches to tackle place-based health inequalities has grown within the public health community, despite their limited evidence. This study aimed to understand how ABAs could promote health and reduce inequalities when implemented in less advantaged neighbourhoods. More specifically, it aimed to identify both ABAs’ key characteristics, and the changes and processes through which ABAs affect inequalities. A qualitative research was conducted in two settings (Valencia and Sheffield) where similar AB initiatives were implemented, aimed at training lay people to become health promoters. Data were collected using theory of change workshops, observations and semi-structured interviews with 44 key stakeholders, including community members, Voluntary and Community Sector organisations’ workers, and health professionals. A thematic analysis informed by systems thinking was carried out to understand the potential impact of ABAs. Three main processes were identified. First, ‘enabling AB thinking’, defined as adopting a positive view to value resources and people’s skills and expertise. Second, ‘developing AB capacities’, described as developing skills, knowledge, self-confidence, and relationships underpinned by AB thinking, to value each other as potential assets. Finally, ‘mobilising AB capacities’, referred to achieving wider changes in the neighbourhoods, resulting from stakeholders mobilising the developed AB capacities beyond the initiatives. Significantly, contextual factors were found key in enabling or hindering these changes to happen. This research adds evidence to the theory of ABAs, as it showed that enabling AB thinking is a key ongoing process throughout. It also provides insights to ABAs’ implementation, as developing and mobilising AB capacities can foster individual empowerment and the development of social capital among stakeholders, although impact on places was limited because of contextual factors. Finally, this study shows that adopting qualitative methods informed by systems thinking can help understand ABAs’ potential to impact on place-based health inequalities.