Marcello Bertotti

A multilevel analysis of the association between social networks and support on leisure time physical activity: Evidence from 40 disadvantaged areas in London

There has been extensive conceptual and empirical work on the associations between social relations and health in recent years. However, the specific pathways through which social interactions impact on health have not been fully elucidated. The aim of this paper is to estimate associations between Leisure Time Physical Activity (LTPA) and social networks and support. Using data from a cross-sectional household survey in 40 disadvantaged lower super-output areas in London, we applied a multilevel model to investigate psychosocial and environmental determinants of physical activity in these populations. Our findings present a strong case for the influence of individual-level social networks on the level of LTPA, although the associations between the types of social support and LTPA were insignificant. We also found that crime rate was an important area-level correlates of LTPA.

Types of social capital and mental disorder in deprived urban areas: a multilevel study of 40 disadvantaged London neighbourhoods.

Objectives To examine the extent to which individual and ecological-level cognitive and structural social capital are associated with common mental disorder (CMD), the role played by physical characteristics of the neighbourhood in moderating this association, and the longitudinal change of the association between ecological level cognitive and structural social capital and CMD. Design Cross-sectional and longitudinal study of 40 disadvantaged London neighbourhoods. We used a contextual measure of the physical characteristics of each neighbourhood to examine how the neighbourhood moderates the association between types of social capital and mental disorder. We analysed the association between ecological-level measures of social capital and CMD longitudinally. Participants 4,214 adults aged 16-97 (44.4% men) were randomly selected from 40 disadvantaged London neighbourhoods. Main Outcome Measures General Health Questionnaire (GHQ-12). Results Structural rather than cognitive social capital was significantly associated with CMD after controlling for socio-demographic variables. However, the two measures of structural social capital used, social networks and civic participation, were negatively and positively associated with CMD respectively. ‘Social networks’ was negatively associated with CMD at both the individual and ecological levels. This result was maintained when contextual aspects of the physical environment (neighbourhood incivilities) were introduced into the model, suggesting that ‘social networks’ was independent from characteristics of the physical environment. When ecological-level longitudinal analysis was conducted, ‘social networks’ was not statistically significant after controlling for individual-level social capital at follow up. Conclusions If we conceptually distinguish between cognitive and structural components as the quality and quantity of social capital respectively, the conclusion of this study is that the quantity rather than quality of social capital is important in relation to CMD at both the individual and ecological levels in disadvantaged urban areas. Thus, policy should support interventions that create and sustain social networks. One of these is explored in this article. Trial Registration Controlled-Trials.com ISRCTN68175121 http://www.controlled-trials.com/ISRCTN68175121

Community engagement using World Café: The Well London experience.

The Well London programme was launched across twenty boroughs in London during late 2007 to improve the health and well-being of residents living in some of the most deprived communities in London. Well London employed a multi-stage community engagement process which informed the overall project strategy for each intervention area. In this article we establish and describe the key principles that guided the design of this innovative community engagement process. Principles included building collaborative partnerships, working with whole-systems, privileging community knowledge and working with the deficit of experience in each area. The article then describes in detail how these principles were operationalised throughout the preparation and delivery of forty World Cafes, which were the first open community activities of the Well London community engagement process. Finally, this article reflects on and summarises the lessons learned when employing innovative, inclusive and transparent community engagement for health promotion.

Reviewing conceptualisations of community: reflections on a meta-narrative approach

Meta-narrative review developed by Greenhalgh and colleagues is a new interpretive systematic review approach within an expanding portfolio of evidence synthesis methods that focus on context, meaning and process. Informed by Kuhn’s notion of scientific paradigms, the method seeks to develop storylines of how research on a given topic unfolds over time, highlighting key discoveries and insights. This article reports how we drew on the meta-narrative approach in a review that examined the changing and contested nature of ‘community’ as understood across disciplines and research traditions. We discuss the challenges that arose in our review and the strengths and limitations of our approach. We conclude that the meta-narrative approach provides a useful framework for making sense of the multiple and changing conceptualisations of community while accounting for historical context. We recommend that an avenue for further development of the method is to consider Foucault’s sociological approach to tracing knowledge.

Reconsidering private sector engagement in subnational economic governance

One consequence of the economic downturn and pressure for public sector reform is a renewed focus upon private sector engagement (PSE) within subnational economic governance. Yet past attempts to promote PSE within urban and regional development policy and governance have been routinely characterised by the partial and uneven involvement of business interests. Adopting a strategic—relational approach, and building upon insights from the developing literature on business—society relations, this paper critically examines how PSE unfolded in a specific spatial and temporal context, through empirical investigation of the evolution of the City Growth Strategy as realised within two areas in London. This analysis explores the difference between policy script and business performance and identifies key dimensions of material self-interest, nonmarket-based rationales, and divergent private/public discourses as critical to the selective nature of emergent PSE strategies and tactics. Critically, these issues remain largely unaddressed within current moves to put in place a private sector led subnational agenda, with clear consequences for understanding its likely impact across differentially constituted urban and regional contexts.

Governance in South Korean social enterprises

Purpose – The aim of the present study is to identify the prevalent model of social enterprise governance in South Korea by empirically testing five conceptual models. Theoretical and empirical research on the governance of social enterprises have grown considerably in the past decade, centred primarily on the UK, Europe and the USA. Whilst some articles have discussed the role and growth of social enterprises in Asia, the empirical evidence remains scant, particularly in relation to empirical studies of social enterprise governance in South Korea. Design/methodology/approach – Drawing upon established literature on social enterprise governance, we empirically tested five conceptual models on a sample of 69 South Korean social enterprises collected through an online survey to identify the prevalent model of governance. Such models were found unable to fully explain governance processes observed. Thus, the authors used an innovative statistical technique, latent class analysis, which identifies clusters of...

A realist evaluation of social prescribing: an exploration into the context and mechanisms underpinning a pathway linking primary care with the voluntary sector

This article adopts a realist approach to evaluate a social prescribing pilot in the areas of Hackney and City in London (United Kingdom). It unpacks the contextual factors and mechanisms that influenced the development of this pilot for the benefits of GPs, commissioners and practitioners, and reflects on the realist approach to evaluation as a tool for the evaluation of health interventions. Primary care faces considerable challenges including the increase in long-term conditions, GP consultation rates, and widening health inequalities. With its emphasis on linking primary care to non-clinical community services via a social prescribing coordinator (SPC), some models of social prescribing could contribute to reduce the burden on primary care, tackle health inequalities and encourage people to make greater use of non-clinical forms of support. This realist analysis was based on qualitative interviews with users, commissioners, a GP survey, focus groups and learning events to explore stakeholders’ experience. To enable a detailed analysis, we adapted the realist approach by subdividing the social prescribing pathway into stages, each with contextual factors, mechanisms and outcomes. SPCs were pivotal to the effective functioning of the social prescribing service and responsible for the activation and initial beneficial impact on users. Although social prescribing shows significant potential for the benefit of patients and primary care, several challenges need to be considered and overcome, including ‘buy in’ from some GPs, branding, and funding for the third sector in a context where social care cuts are severely affecting the delivery of health care. With its emphasis on context and mechanisms, the realist evaluation approach is useful in understanding how to identify and improve health interventions, and analyse in greater detail the contribution of different stakeholders. As the SPC is central to social prescribing, more needs to be done to understand their role conceptually and practically.

Social, cognitive, behavioural and neighbourhood characteristics associated with sedentary time in men and women living in deprived neighbourhoods

Abstract Multiple individual and neighbourhood characteristics are theorised to influence adult sedentary behaviour. The aim of this study was to examine associations between individual and neighbourhood-level characteristics in 40 deprived neighbourhoods in London, UK. A cross-sectional design was utilised with baseline data from the Well London Cluster Randomised Controlled Trial in 40 deprived neighbourhoods in London. Multilevel linear regression was used to examine associations between individual characteristics (measured by household survey), neighbourhood characteristics (neighbourhood audit, GIS and routinely available datasets) and sedentary behaviour (sitting time). Individual-level positive mental well-being and health behaviours were associated with sedentary time. Individual-level social networks were associated with decreased sedentary time in men and increased sedentary time in women. Neighbourhood-level measures of social networks and perceived neighbourhood quality were associated with reduced sedentary time. Fifteen per cent of the variance in sedentary time was attributable to differences at the neighbourhood level (intra-class correlation coefficient = 0.15). These findings suggest that social networks at the individual and neighbourhood levels, collective perceptions of neighbourhood quality, individual-level positive mental well-being and other health behaviours may be important components of interventions developed to reduce sedentary time in deprived populations.