Amidst a growing recognition that traditional public heath approaches are insufficient to meet the 21st century challenges confronting population health, there are urgent calls for the development of new types of approaches. Despite greater understanding about what determinants influence population health and wellbeing, knowledge about how determinants interact together to create sustainable health outcomes is lacking, and as such the way we think about public health interventions is constrained. With a focus on health creating processes (salutogeneis), this longitudinal qualitative study adopted a complexity perspective and a whole systems approach to examine how two exemplary communities in Cornwall, a factory workplace and a community partnership, succeeded in creating long-term sustainable population behaviour change towards wellbeing. With a multiple case study method where each community was studied as a case in its own right, a total of 45 interviews and 22 observations were conducted over a period of 19 months. For each case an iterative-inductive ethnographic approach constituting purposive and snowball sampling and data collection was conducted concurrently with a six step thematic analyses. The two sets of data were subjected to a cross case comparison where ‘within case’ themes from both cases were grouped together to form sets of ‘higher order’ themes which were translated into five overarching concepts: relational properties, dynamics and processes, identity, learning about and telling stories, valuing and being valued. Finally the data as a whole was interrogated from the perspective of complexity theory, where principles such as self-organization, emergence, feedback loops and attractors were utilized. Whilst the cross case comparison identified a number of conditions in common between the communities, using complexity theory as a sense making tool enabled an explication of how such conditions, related to non-linear processes, were significant for sustainable population behaviour change. The findings of the research delineate non-linear processes that enabled each community to creatively respond to continuous changes in need and resources. Through the decontextualisation and then crystalisation of higher order concepts attributed to sustainable salutogenic behavior change in two distinct communities, the research offers a transferable framework of five domains of conditions, that other communities and organisations may attend to when facilitating such behaviour in their own contexts. Furthermore, the results illustrate a detailed theoretical and dynamic understanding of the interplay between macro and micro levels of a system, that together, and supported by the five domains of conditions, generate sustainable salutogenic change. In a climate of emerging complex public health challenges this research may assist those wishing to develop whole systems approaches that harness non-linear health creating properties inherent in populations within the context of salutogenic settings.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:720883 |
| Date | January 2017 |
| Creators | Buckwell, Margot Cherry |
| Publisher | Exeter and Plymouth Peninsula Medical School |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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