Adapting, expanding and embedding community and culture into health ecosystems

Abstract Background Community anchor organisations (CAOs) work with communities who experience health inequalities and disadvantage, providing a range of activities and services to meet individuals’ needs in an integrated way. This study explored how CAOs use art, cultural and nature-based activities as part of their work to respond to the needs of people facing inequalities and considered how activities can be scaled in this health setting. Methods This study used community-based participatory research within a case study approach to work with four purposively sampled CAOs. Participants were community members, volunteers, staff, trustees, partner organisations and commissioners. Data collection methods included: document analysis, interviews (n = 45), workshops (n = 5) and focus groups (n = 11). This study was also supported by data collected by trained community researchers (n = 18). Framework analysis was conducted for within- and cross-case analysis. Results In the context of CAOs, the delivery of art, cultural and nature-based activities were found to be an important mechanism for developing trusted relationships with marginalised groups, who may lack trust in statutory services and health focused activities. Other facilitators to community engagement were the CAOs’ longevity, localness and co-location of services within a trusted and familiar place that connect people to personalised support. Barriers to scaling up included funding models as well as insufficient dialogue and understanding between CAOs and the local public health ecosystem. Conclusions CAOs have long term trusted relationships with disadvantaged communities and are influential in connecting individuals with projects and services. Findings suggest that the effectiveness of action to address inequality through art, cultural and nature-based activities could be improved if the role of CAOs was recognised more coherently in place-based public health plans. Key messages • Creative activities enable meaningful engagement with disadvantaged groups within place-based settings. • CAOs must be recognised more coherently in place-based strategies to reduce health inequalities.