Sustainability processes in community-level health initiatives: the experiences of Scottish healthy living centres
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Background This thesis explores processes involved in stakeholders’ attempts to secure sustainability of three short-term funded community health initiatives known as healthy living centres (HLCs). The overall aim was to identify and examine development of sustainability strategies in Scottish HLC organisations. In contrast to retrospective accounts examining influences on extent of sustainability little is known about how this concept is considered by organisations approaching the end of funding. Organisational development theorising has focused on organisational change, with no attention given to sustainability processes in short-term funded organisations. Building on a concurrent longitudinal evaluation of a larger sample of HLCs, the temporal nature of this PhD study offered scope to explore development of, influences on and changes to stakeholders’ sustainability strategies over time. Methods The study used a qualitative evaluation methodology. A case study approach framed the HLCs, permitting comparison between sites. An ethnographic approach using observations and in-depth interviews was employed. Interviews were undertaken with stakeholders (comprising managers, staff, partners and board members) from each HLC. Managers were interviewed on several occasions. Latterly, interviews were undertaken with respondents holding policy, practice and funding posts. A thematic analysis, informed by grounded theory, was carried out. This used a constant comparative methodology to understand the data against the backdrop of the PhD study aims and wider literature. Findings Findings examine stakeholders’ accounts of the impact of a range of issues on HLC sustainability strategies. These are located in the context of health and community sector restructuring. Especially challenging were: efforts to secure local partners and further lottery funding; consideration of new funding criteria and models of service delivery; and limitations in demonstrating effectiveness. Addressing such challenges, managers’ strategic positioning signified attempts to influence HLCs’ fit within local health structures. Stakeholders’ accounts highlighted attempts to secure continuation of HLCs’ original identity; ensuring continued accessibility of Centres to local communities; and, seeking continuation of developmental methods of work. External respondents’ perspectives illuminated how policy-driven changes restricted system-wide attention to HLC sustainability. Latterly, Government-provided funding offered a short-term fix, enabling continuation of attempts to secure sustainability. Conclusions and implications This study offers new perspectives on the temporal exploration of sustainability of shortterm funded health initiatives. Analysis of stakeholders’ accounts over time provides insight into the effects of restructuring and ways in which system-wide flux impacted on influences known to enhance the likelihood of sustainability. Recommendations address programme design and wider responsibilities of health system actors in positioning and considering a future for such organisations after short-term funding ends.