The culture of community engagement from participant perspectives: implications for health visiting.

The ‘Big Society’ idea proposed by David Cameron (2010a) suggests that civil society take an active role in supporting community members and promoting self-determination. To date, the processes of the public sector and professional powers have limited the ability of communities to make such changes and are a barrier to the development of community engagement (National Institute for Health and Care Excellence) (NICE) 2008). It is argued that community engagement has the potential to improve health, yet there is limited understanding about how this works (NICE 2008). This study has taken a critical ethnographic approach to explore community engagement from the perspective of community members who are actively engaged in the process. The study explored this perspective within a community centre and involved volunteers, users and managers of the facility, exploring the concept of community and levels of engagement. The findings, presented in three major themes of ‘Volunteers’, ‘Community’ and ‘Conflict’, illuminate how the culture of civil society is different from that of the public services, suggesting that social interactions nurture and sustain community members. This is in contrast to the hierarchical structures of public services and the economic focus that has been prevalent in regeneration projects. The current Coalition Government has focused on the development of health visiting and has re-introduced the community aspect of health visiting practice (Great Britain, Department of Health 2011a). The findings of this study are timely and indicate that if health visitors are to build community capacity as envisaged then they must be sensitive to the cultures and practices of communities, and engage with communities rather than expect communities to engage with the health visiting service.