Conceptualizing the health and well-being impacts of social enterprise: a UK-based study

The Health Impact of Social Community Enterprises in Vulnerable Neighborhoods: Protocol for a Mixed Methods Study

Background

This 4-year research project focuses on 6 social community enterprises (SCEs) that operate in 5 neighborhoods in a Dutch city. Residents of these neighborhoods face problems such as poor average levels of physical and mental health, high unemployment rates, and weak social cohesion. SCEs offer residents social, cultural, and work-related activities and are therefore believed to help these persons develop themselves and strengthen the social ties in the community. Because of a lack of empirical evidence; however, it is unclear whether and how SCEs benefit the health and well-being of participants.

Objective

This paper outlines a protocol for an evaluation study on the impact of SCEs, aiming to determine (1) to what extent SCEs affect health and well-being of participating residents, (2) what underlying processes and mechanisms can explain such impact, and (3) what assets are available to SCEs and how they can successfully mobilize these assets.

Methods

A mixed methods multiple-case study design including repeated measurements will be conducted. Six SCEs form the cases. An integrated model of SCE health intervention will be used as the theoretical basis. First, the impact of SCEs is measured on the individual and community level, using questionnaires and in-depth interviews conducted with participants. Second, the research focuses on the underlying processes and mechanisms and the organizational and sociopolitical factors that influence the success or failure of these enterprises in affecting the health and well-being of residents. At this organizational level, in-depth interviews are completed with SCE initiators and stakeholders, such as municipal district managers. Finally, structurally documented observations are made on the organizational and sociopolitical context of the SCEs.

Results

This research project received funding from the Netherlands Organization for Health Research and Development in 2018. Data collection takes place from 2018 until 2022. Data analysis starts after the last round of data collection in 2022 and finalizes in 2024. Expected results will be published in 2023 and 2024.

Conclusions

Despite the societal relevance of SCEs, little empirical research has been performed on their functioning and impact. This research applies a variety of methods and includes the perspectives of multiple stakeholders aiming to generate new empirical evidence. The results will enable us to describe how SCE activities influence intermediate and long-term health outcomes and how the organizational and sociopolitical context of SCEs may shape opportunities or barriers for health promotion. As the number of these initiatives in the Netherlands is increasing rapidly, this research can benefit many SCEs attempting to become more effective and increase their impact. The findings of this research will be shared directly with relevant stakeholders through local and national meetings and annual reports and disseminated among other researchers through scientific publications.

International Registered Report Identifier (IRRID)

DERR1-10.2196/37966

The health and well-being impacts of a work integration social enterprise from a systems perspective

Recent research has drawn upon the social determinants of health (SDH) framework to attempt to systematize the relationship between social enterprise and health. In this article, we adopt a realist evaluation approach to conceptualize social enterprises, and work integration social enterprises in particular, as 'complex interventions' that necessarily produce differential health outcomes for their beneficiaries, communities and staff. Drawing upon the findings from four social enterprises involving a range of methods including 93 semi-structured interviews with employees, managers and enterprise partners, together with participant observation, we demonstrate that these health outcomes are influenced by a limitless mix of complex and dynamic interactions between systems, settings, spaces, relationships and organizational and personal factors that cannot be distilled by questions of causality and attribution found in controlled trial designs. Given the increased policy focus on the potential of social enterprises to affect the SDH, this article seeks to respond to evidence gaps about the mechanisms and contexts through which social enterprises promote or constrain health outcomes, and thereby provide greater clarity about how research evidence can be used to support the social enterprise sector and policy development more broadly.

Social enterprises' impact on older people's health and wellbeing: exploring Scottish experiences

The global aging demographic is putting pressure on state-delivered health and social care services. As the austerity agenda in the UK cuts state-funded service provision for older people despite increasing demand, social enterprise has become a politically and economically attractive model for the sustainable delivery of some public services. Yet little is known about the impact of social enterprise on the health and wellbeing of older people. In this paper we address this gap in understanding and consider social enterprise activities as complex public health-promoting interventions. Our study aimed to understand what impact social enterprise activities had on the health and wellbeing of participants aged over 50, and also how that impact was created. To achieve this, we conducted qualitative semi-structured interviews with a sample (n = 43) of staff, volunteers, clients and carers aged over 50 who were involved in activities delivered by three social enterprises. Using a thematic analysis to explore manifest and latent themes, two antecedents of subjective younger age emerged explaining how benefit was created, namely downward social comparison and identity. The social enterprise activities we studied benefited participants' health and wellbeing, impacting positively on participants' sense of purpose, social support, connectedness and inclusion. These health and wellbeing benefits can be considered as outcomes of complex public health interventions for older people, and we relate these outcomes to beneficial conditions within the intermediary social determinants of health. We conclude by discussing the future impact of social enterprise activities and current UK policy on the structural determinants of health.

Working Conditions in Social Firms and Health Promotion Interventions in Relation to Employees' Health and Work-Related Outcomes-A Scoping Review

Background: Social firms—a type of social enterprise—offer people with severe disabilities the possibility of employment and integration into the labor market. Since 01 January 2018, social firms in Germany are obligated to provide health promotion interventions for their employees. Therefore, the study aims to provide an overview of the current state of research on working conditions, coping strategies, work- and health-related outcomes, and health promotion interventions in social firms to derive recommendations for action. Methods: The databases PubMed, MEDLINE, PsycINFO, PSYNDEX, CINAHL, and Web of Science were searched. The study selection was based on predefined inclusion and exclusion criteria in the time period between 2000 and 2019. The quality of the studies was critically appraised in a standardized way using the Mixed-Methods Appraisal Tool. Results: A total of 25 studies were included. The current state of research indicated that employees with disabilities were provided with several environmental resources like social support, flexibility, structured work tasks or options for training. A mix of environmental and personal resources impacted several work- and health-related outcomes like well-being, job satisfaction, productivity, work engagement, the motivation to work, or job tenure. Conclusions: There is a need for further (longitudinal) research concerning the work and health situation of employees working in social firms and the development of health promotion interventions.

Filling a void? The role of social enterprise in addressing social isolation and loneliness in rural communities

Social isolation and loneliness has been classed as a major public health concern due to its negative physical and mental health implications, and living in a remote or rural area is a prominent contributing risk factor. Community-led social enterprise models are recognised in government policy as a potential preventative measure for social isolation and loneliness, yet there is a lack of understanding of their application in rural contexts. The objectives of this paper are to investigate the role of social enterprise in addressing social isolation and loneliness in rural communities, and to explore the pathways in which social enterprise activity may act upon the health and wellbeing of social enterprise beneficiaries. We also discuss the capacity of rural community members to deliver and sustain such services. The study used in-depth interviews over a three-year period with 35 stakeholders from seven social enterprises in the Highlands and Islands of Scotland, including board members, staff, volunteers and service users. Findings showed that social enterprises are successfully providing activities that counteract factors contributing to social isolation and feelings of loneliness, leading to wider health and wellbeing benefits for individuals. However, the sustainability and continuity of social enterprises are questionable due to the burden on smaller populations, limited expertise and knowledge of running social enterprises, and effects on the personal lives of social enterprise volunteers and staff. This study supports suggestions that social enterprises can be generators of health and wellbeing through their varied remit of activities that impact on the social determinants of health. However, it also shows that relying on social enterprise as a particular solution to social isolation and loneliness is precarious due to complexities associated with rurality. Therefore, rural policy and practice must move away from a 'one size fits all' approach to tackling social isolation and loneliness, recognise the need for local level tailored interventions and, through harnessing the potential or rural social enterprises, enable flexible service provision that correlates with rural context.

Social enterprises and public health improvement in England: a qualitative case study

OBJECTIVES

To explore the contribution of social enterprises to publicly commissioned public health improvement and assess the risks and benefits of their role.

STUDY DESIGN

Qualitative case study of four south London boroughs.

METHODS

Documentary research; in-depth interviews with 19 key informants.

RESULTS

This study identified 24 social enterprises that were currently commissioned to contribute to public health improvement. These organisations ranged in size, longevity, and structure. They were widely reported as flexible and able to rapidly develop services responsive to local community needs. Their work often addressed upstream health determinants. However, to capitalise on securing contracts, they had to bureaucratise and establish provider alliances, which risked losing the very characteristics that make them unique. Social enterprises bore the financial risk of innovative service developments. Emerging mixed economies of public health were fragmented, limiting commissioners' abilities to plan strategically and evaluate the impact.

CONCLUSIONS

Social enterprises have an increasing role in providing potential solutions to intractable health improvement challenges, contributing to a broader vision around upstream action for health. However, the fragmentation and growing outsourcing of public health has risks for coherent and equitable service planning.

Differentiating the effect of social enterprise activities on health

An emerging stream of literature has focused on the ways in which social enterprises might act on the social determinants of health. However, this previous work has not taken a sufficiently broad account of the wide range of stakeholders involved in social enterprises and has also tended to reduce and simplify a complex and heterogeneous set of organisations to a relatively homogenous social enterprise concept. In an attempt to address these gaps, we conducted an empirical investigation between August 2014 and October 2015 consisting of qualitative case studies involving in-depth semi-structured interviews and a focus group with a wide variety of stakeholders from three social enterprises in different regions of Scotland. We found that different forms of social enterprise impact on different dimensions of health in different ways, including through: engendering a feeling of ownership and control; improving environmental conditions (both physical and social); and providing or facilitating meaningful employment. In conclusion, we highlight areas for future research.