Collaborator or competitor: assessing the evidence supporting the role of social enterprise in health and social care

Figures & data

Figure 1. Results of the search and study selection process.

Table 1. Social enterprise as a substitute to usual care: papers included.

Paper	Intervention	Methodological approach	Design study	Sample	Quality assessment
Gardner, Burton, and Klimes (2006)	Parenting Programme for reducing conduct problems with children	Quantitative	Randomized Controlled Trial	76 families	Strong
Edwards et al. (2009)	Social activities and peer support for people with leg ulcers	Quantitative	Randomized Controlled Trial	67 patients	Moderate
Shepherd et al. (1996)	Providing residential care for adults with chronic conditions	Quantitative	Case control	20 community houses	Moderate
Knapp et al. (1999)	Providing community support for adults with mental health issues	Quantitative	Case control	429 patients	Moderate
Luo and Yu (1994)	Work therapy station for mentally ill patients	Quantitative	Case control	156 patients	Moderate
Allen et al. (2012)	Providing healthcare	Qualitative	Case studies	48 interviews	Moderate
Khan and Ahmed (2003)	Nutritional programme for women	Quantitative	Case control	35 community centres	Weak

Table 2. Social enterprise as a complement to usual care: papers included.

Paper	Intervention	Methodological approach	Design study	Sample	Quality assessment
Higgins, McKevitt, and Wolfe (2005)	Reading service for people affected by stroke	Qualitative	Interviews and participant observation	29 interviews	Strong
Norman (2006)	Work integration social enterprise for people with mental health issues	Qualitative	Interviews and focus groups	32 focus groups and 7 interviews	Moderate
Stathi and Sebire (2011)	Community development activities for children	Qualitative	Interviews and focus groups	24 interviews	Moderate
Greenspan and Handy (2008)	Community development activities for women with breast cancer	Qualitative	Interviews	15 interviews	Moderate
Jones et al. (2013)	Community development activities for adults with chronic conditions	Quantitative	Cohort Design	841 beneficiaries	Moderate
Hawk and Davis (2012)	Housing and support for people with HIV	Quantitative	Cohort Design	26 beneficiaries	Moderate
Leroux (2005)	Physical activity for people affected by stroke	Quantitative	Cohort Design	20 people	Weak
Cheifetz et al. (2014)	Physical activity for people with cancer	Quantitative	Cohort Design	115 beneficiaries	Weak
Jackson et al. (2009)	Work integration social enterprise for people with mental health issues	Quantitative	Cohort Design	37 beneficiaries	Weak
Zabriskie, Lundberg, and Groff (2005)	Physical activity for people with disabilities	Quantitative	Survey	129 clients	Weak
Ewles et al. (2001)	Community development activities for people with chronic conditions	Qualitative	Not Reported	Not Reported	Weak
Kirrmann (2010)	Arts and Crafts workshops for people with chronic conditions	Qualitative	Not Reported	Not Reported	Weak
Lysaght, Jakobsen, and Granhaug (2012)	Work integration social enterprise for people with intellectual disabilities	Qualitative	Case studies	Not Reported	Weak
Ferguson (2012)	Work integration social enterprise for young homeless people	Mixed Methods	Quasi Experiment and In-depth case study	28 beneficiaries	Strong (92%)
Finn, Bishop, and Sparrow (2007)	Befriending groups for people with mental health issues	Mixed Methods	Cohort Design and Ethnographic study	54 beneficiaries (cohort study) and survey 907 members	Strong (83%)
Williams, Fossey, and Harvey (2012)	Work integration social enterprise for people with mental health issues	Mixed Methods	Survey and Semi-structured interviews	7 beneficiaries	Strong (75%)
Jenkins, Brigden, and King (2013)	Community development activities for people with chronic conditions	Mixed Methods	Cohort Design, Focus Group and In-depth interview	48 beneficiaries	Moderate (33%)
Keller et al. (2004)	Community development activities for people with chronic conditions	Mixed Methods	Cohort Design and In depth interviews	19 beneficiaries	Weak (8%)

Table 3. Social enterprise results.

Outcomes	Papers	Collaborative or Competitive settings	Results
Physical Health	Edwards et al. (2009)	Competitive	Both improvements and deteriorations
	Knapp et al. (1999)	Competitive	Both improvements and deteriorations
	Jones et al. (2013)	Collaborative	Improvement
	Hawk and Davis (2012)	Collaborative	Improvement
	Leroux (2005)	Collaborative	Both improvements and deteriorations
	Cheifetz et al. (2014)	Collaborative	Both improvements and deteriorations
	Jenkins, Brigden, and King (2013)	Collaborative	Improvement
	Stathi and Sebire (2011)	Collaborative	Improvement
	Ewles et al. (2001)	Collaborative	Improvement
Mental Health	Gardner, Burton, and Klimes (2006)	Competitive	No Differences
	Edwards et al. (2009)	Competitive	No Differences
	Luo and Yu (1994)	Competitive	Improvement
	Jones et al. (2013)	Collaborative	Improvement
	Ferguson (2012)	Collaborative	Both improvements and no differences
	Finn, Bishop, and Sparrow (2007)	Collaborative	Improvement
Well-Being	Gardner, Burton, and Klimes (2006)	Competitive	Improvement
	Edwards et al. (2009)	Competitive	Improvement
	Shepherd et al. (1996)	Competitive	No Differences
	Jones et al. (2013)	Collaborative	Improvement
	Cheifetz et al. (2014)	Collaborative	No Differences
	Ferguson (2012)	Collaborative	Improvement
	Finn, Bishop, and Sparrow (2007)	Collaborative	Improvement
	Williams, Fossey, and Harvey (2012)	Collaborative	Improvement
	Keller et al. (2004)	Collaborative	Improvement
	Higgins, McKevitt, and Wolfe (2005)	Collaborative	Improvement
	Stathi and Sebire (2011)	Collaborative	Improvement
	Greenspan and Handy (2008)	Collaborative	Improvement
	Ewles et al. (2001)	Collaborative	Improvement
	Kirrmann (2010)	Collaborative	Improvement
Connectedness	Edwards et al. (2009)	Competitive	No Differences
	Jones et al. (2013)	Collaborative	No Differences
	Ferguson (2012)	Collaborative	Improvement
	Zabriskie, Lundberg, and Groff (2005)	Collaborative	No Differences
	Jenkins, Brigden, and King (2013)	Collaborative	Improvement
	Keller et al. (2004)	Collaborative	Improvement
	Higgins, McKevitt, and Wolfe (2005)	Collaborative	Improvement
	Norman (2006)	Collaborative	Improvement
	Stathi and Sebire (2011)	Collaborative	Improvement
	Greenspan and Handy (2008)	Collaborative	Improvement
	Ewles et al. (2001)	Collaborative	Improvement
	Finn, Bishop, and Sparrow (2007)	Collaborative	Improvement
	Kirrmann (2010)	Collaborative	Improvement
	Lysaght, Jakobsen, and Granhaug (2012)	Collaborative	Improvement
Confidence and empowerment	Gardner, Burton, and Klimes (2006)	Competitive	Improvement
	Edwards et al. (2009)	Competitive	Improvement
	Ferguson (2012)	Collaborative	Improvement and no differences
	Finn, Bishop, and Sparrow (2007)	Collaborative	Improvement
	Jenkins, Brigden, and King (2013)	Collaborative	Improvement
	Keller et al. (2004)	Collaborative	Improvement
	Stathi and Sebire (2011)	Collaborative	Improvement
	Ewles et al. (2001)	Collaborative	Improvement
	Kirrmann (2010)	Collaborative	Improvement
	Lysaght, Jakobsen, and Granhaug (2012)	Collaborative	Improvement
Costs Difference	Shepherd et al. (1996)	Competitive	No results
	Knapp et al. (1999)	Competitive	Higher and Lower
	Khan and Ahmed (2003)	Competitive	No Differences
Medication and health service utilization	Luo and Yu (1994)	Competitive	Improvement
	Jackson et al. (2009)	Collaborative	Both improvements and deteriorations
	Finn, Bishop, and Sparrow (2007)	Collaborative	Improvement
	Kirrmann (2010)	Collaborative	Improvement
Other outcomes	Allen et al. (2012)	Competitive	Improvement

Table

Criteria	Inclusion	Exclusion
Population	Social enterprises and or/third sector organizations in health and social care sector which provide any type of service(s). The decision is to analyse social enterprises and/or third sector organizations without evaluating specific beneficiaries or services (e.g. old, young people, specific marginalities). The reason behind this choice is related to the necessary inclusion of all the services that social enterprises provide in health and social care. Sources which evaluate third sector results are taken into consideration in order to include all papers that do not use the social enterprise definition in order to understand if it is possible to use similar lenses to analyse social enterprise.	The review will not include papers analysing non-profit hospitals, foundation trusts, dialysis centres or nursing care homes because they are not relevant to the research.
Interventions or Exposure	Performance in terms of the efficacy and efficiency of social enterprises and/or third sector organizations in comparison with for-profit and public providers in all kind of activity related to the health and social care sector.	The review will not include papers which do not compare at least one of the other service providers
Outcomes	The possible outcomes related to the research questions are the following: ● Quality of care: results in terms of core service and care (mortality rates, number of/problems/issues, improvement in life expectancy, improvement of health condition)● Quality of life: The impact on the quality of life of stakeholders (not only beneficiaries, but also general stakeholders such as employees and volunteers)● Innovation: innovation in terms of intervention● Efficiency: results in terms of economic efficiency and financial performanceOutcomes reported by the beneficiaries themselves and/or significant others● Outcomes related to beneficiaries reported by the employees themselves, funders, or significant other stakeholders Studies which include at least one of the above outcomes will be included in the analysis.	Studies which do not include at least one of the outcomes underlined in the inclusion criteria will not be included
Study and Design	Comparative studies of any design (qualitative and quantitative, experimental, semi-experimental) examining any type of performance (efficacy, efficiency or both) in at least two population groups which include social enterprises or third sector organizations are included. Moreover, all systematic reviews related to the topic will be evaluated in order to obtain their reference lists and identify possible papers.	Studies which do not compare at least two categories will be excluded. Opinion papers will not be included. Studies developed in languages other than English will not be included.

Gardner, F., J. Burton, and I. Klimes. 2006. “Randomised Controlled Trial of a Parenting Intervention in the Voluntary Sector for Reducing Child Conduct Problems: Outcomes and Mechanisms of Change.” Journal of Child Psychology and Psychiatry 47 (11): 1123–1132. doi:10.1111/j.1469-7610.2006.01668.x.

 PubMed Web of Science ®Google Scholar

Edwards, H., M. Courtney, K. Finlayson, P. Shuter, and E. Lindsay. 2009. “A Randomised Controlled Trial of A Community Nursing Intervention: Improved Quality of Life and Healing for Clients with Chronic Leg Ulcers.” Journal of Clinical Nursing 18 (11): 1541–1549. doi:10.1111/j.1365-2702.2008.02648.x.

 PubMed Web of Science ®Google Scholar

Shepherd, G., M. Muijen, R. Dean, and M. Cooney. 1996. “Residential Care in Hospital and in the Community - Quality of Care and Quality of Life.” British Journal of Psychiatry 168 (4): 448–456. doi:10.1192/bjp.168.4.448.

 PubMed Web of Science ®Google Scholar

Knapp, M., A. Hallam, J. Beecham, and B. Baines. 1999. “Private, Voluntary or Public? Comparative Cost-Effectiveness in Community Mental Health Care.” Policy & Politics 7 (1): 25–41. doi:10.1332/030557399782019589.

 Google Scholar

Luo, K., and D. Yu. 1994. “Enterprise-Based Sheltered Workshops in Nanjing. A New Model for the Community Rehabilitation of Mentally Ill Workers.” The British Journal of Psychiatry. 165 (Suppl 24): 89–95.

 Web of Science ®Google Scholar

Allen, P., S. Turner, W. Bartlett, V. Perotin, G. Matchaya, and B. Zamora. 2012. “Provider Diversity in the English NHS: A Study of Recent Developments in Four Local Health Economies.” Journal of Health Services Research & Policy 17 (S1): 23–30. doi:10.1258/jhsrp.2011.011015.

 PubMedGoogle Scholar

Khan, M. M, and S. Ahmed. 2003. “Relative Efficiency of Government and Non-Government Organisations in Implementing a Nutrition Intervention Programme–A Case Study from Bangladesh.” Public Health Nutrition 6 (1): 19–24. doi:10.1079/PHN2002359.

 PubMed Web of Science ®Google Scholar

Higgins, M., C. McKevitt, and C. D. A. Wolfe. 2005. “Reading to Stroke Unit Patients: Perceived Impact and Potential of an Innovative Arts Based Therapy.” Disability & Rehabilitation 27 (22): 1391–1398. doi:10.1080/09638280500164727.

 PubMed Web of Science ®Google Scholar

Norman, C. 2006. “The Fountain House Movement, an Alternative Rehabilitation Model for People with Mental Health Problems, Members Descriptions of What Works.” Scandinavian Journal of Caring Sciences 20 (2): 184–192. doi:10.1111/j.1471-6712.2006.00398.x.

 PubMed Web of Science ®Google Scholar

Stathi, A., and S. J. Sebire. 2011. “A Process Evaluation of an Outreach Physical Activity Program in an Inner-City Primary School.” Journal of Physical Activity & Health 8 (Sep.): S239–S248. doi:10.1123/jpah.8.s2.s239.

 Google Scholar

Greenspan, I., and F. Handy. 2008. “From Discovery to Recovery and Beyond: The Role of Voluntary Health Sector Organizations in the Lives of Women with Breast Cancer.” In Patients, Consumers and Civil Society 10, edited by S. M. Chambre and M. Goldner, 151–176. doi:10.1016/S1057–6290(08)10008–0.

 Google Scholar

Jones, M., R. Kimberlee, T. Deave, and S. Evans. 2013. “The Role of Community Centre-Based Arts, Leisure and Social Activities in Promoting Adult Well-Being and Healthy Lifestyles.” International Journal of Environmental Research and Public Health 10 (5): 1948–1962. doi:10.3390/ijerph10051948.

 PubMed Web of Science ®Google Scholar

Hawk, M., and D. Davis. 2012. “The Effects of a Harm Reduction Housing Program on the Viral Loads of Homeless Individuals Living with HIV/AIDS.” AIDS Care - Psychological and Socio-Medical Aspects of AIDS/ HIV 24 (5): 577–582. doi:10.1080/09540121.2011.630352.

 PubMed Web of Science ®Google Scholar

Leroux, A. 2005. “Exercise Training to Improve Motor Performance in Chronic Stroke: Effects of a Community-Based Exercise Program.” International Journal of Rehabilitation Research 28 (1): 17–23. doi:10.1097/00004356–200503000–00003.

 PubMed Web of Science ®Google Scholar

Cheifetz, O., J. P. Dorsay, G. Hladysh, J. MacDermid, F. Serediuk, and L. J. Woodhouse. 2014. “CanWell: Meeting the Psychosocial and Exercise Needs of Cancer Survivors by Translating Evidence into Practice.” Psycho-Oncology 23 (2): 204–215. doi:10.1002/pon.3389.

 PubMed Web of Science ®Google Scholar

Jackson, Y., J. Kelland, T. D. Cosco, D. C. McNeil, and J. R. Reddon. 2009. “Nonvocational Outcomes of Vocational Rehabilitation: Reduction in Health Services Utilization.” Work 33 (4): 381–387. doi:10.3233/WOR–2009–0886.

 PubMedGoogle Scholar

Zabriskie, R. B., N. R. Lundberg, and D. G. Groff. 2005. “Quality of Life and Identity: The Benefits of a Community-Based Therapeutic Recreation and Adaptive Sports Program.” Therapeutic Recreation Journal 39 (3): 176–191.

 Google Scholar

Ewles, L., W. Harris, E. Roberts, and M. Shepherd. 2001. “Community Health Development on A Bristol Housing Estate: A Review of A Local Project Ten Years On.” Health Education Journal 60 (1): 59–72. doi:10.1177/001789690106000107.

 Google Scholar

Kirrmann, K. 2010. “CoolTan Arts - Enhancing Well-Being through the Power of Creativity.” Mental Health & Social Inclusion 14 (2): 12–16. doi:10.5042/mhsi.2010.0236.

 Google Scholar

Lysaght, R., K. Jakobsen, and B. Granhaug. 2012. “Social Firms: A Means for Building Employment Skills and Community Integration.” Work 41 (4): 455–463. doi:10.3233/WOR–2012–1313.

 PubMedGoogle Scholar

Ferguson, K. 2012. “Merging the Fields of Mental Health and Social Enterprise: Lessons from Abroad and Cumulative Findings from Research with Homeless Youths.” Community Mental Health Journal 48 (4): 490–502. doi:10.1007/s10597-011-9440–7.

 PubMed Web of Science ®Google Scholar

Finn, L. D., B. Bishop, and N. H. Sparrow. 2007. “Mutual Help Groups: An Important Gateway to Wellbeing and Mental Health.” Australian Health Review 31 (2): 246–255. doi:10.1071/AH070246.

 PubMed Web of Science ®Google Scholar

Williams, A., E. Fossey, and C. Harvey. 2012. “Social Firms: Sustainable Employment for People with Mental Illness.” Work 43 (1): 53–62. doi:10.3233/WOR–2012–1447.

 PubMedGoogle Scholar

Jenkins, L., C. Brigden, and A. King. 2013. “Evaluating a Third Sector Community Service following Stroke.” Journal of Integrated Care 21 (5): 248–262. doi:10.1108/JICA-05-2013–0015.

 Google Scholar

Keller, H. H., A. Gibbs, S. Wong, P. Vanderkooy, and M. Hedley. 2004. “Men Can Cook! Development, Implementation, and Evaluation of a Senior Men’s Cooking Group.” Journal of Nutrition for the Elderly 24 (1): 71–87. doi:10.1300/J052v24n01_06.

 PubMedGoogle Scholar