Realist evaluation of social outcomes in community care: the application of affordance theory to the Lindsay Leg Clubs

ABSTRACT

This study uses a scientific realist methodology to explain how social outcomes of community care interventions are produced, sustained and contextually dependent. We evaluate an organization dedicated to wound care and leg health known as the Lindsay Leg Club network, so far studied mostly from a phenomenological perspective, to demonstrate the generative role of places where Leg Clubs are located, with objects in their environment, and people who organize and run Leg Clubs, with their agency and intentionality. We theorize the explanatory role of these contextual features with the concept of affordances. Our approach shows that the phenomenological findings from community care evaluation are not unequivocal. Instead, researchers should recognize the nuanced nature of causality in social programmes, which requires a consideration of the links between community care interventions, how people respond to them and the conditions under which these responses are enacted.

KEYWORDS:

• Affordance
• community care
• Leg Club Network
• realist evaluation
• wound care

Disclosure statement

This publication was prepared during Dr Anna Milena Galazka’s post-doctoral research training funded by the Welsh Wound Innovation Centre via Mölnlycke Health Care. Dr Anna Galazka is a project consultant for the Lindsay Leg Club Foundation. The Foundation had no involvement in the funding support and preparation of the article.

Notes

1 Our evaluation team was lead by social scientists, which vindicated our focus on the understudied mechanisms of social outcomes, to the exclusion of the healing and recurrence outcomes of the provision of preventative and medical care, documented elsewhere (Gordon et al. 2006; Edwards et al. 2009).

2 The activities of organizing and running the Leg Clubs relate to the social organization of the Leg Clubs. The core principles of clinical practice and infection control are set regardless of the social environment (Young 2010).

Additional information

Funding

This work was supported by Mölnlycke Health Care. The funder had no involvement in the preparation of the article.

Notes on contributors

Anna Milena Galazka

Anna Galazka is a Lecturer in the Management, Employment and Organisation section. Her primary research interests include the transformative power of positive relationships and community, reflexivity, social innovation, emancipation, stigma and dirty work, which she has explored in the context of wound healing medical work. After completing her doctorate on organizing healthcare with a focus on clinician-patient relations in wound healing at Cardiff Business School, she worked as a post-doctoral research consultant at the Welsh Wound Innovation Centre in collaboration with Cardiff Business School. Her additional research interests include knowledge management and learning, entrepreneurship and new ways of working and organizing work. She also has a particular interest in the role of information and communication technologies in the world of work, as developed during her collaboration with the International Labour Organization.

Tim Edwards

Tim Edwards is head of the Management, Employment and Organisation Group at Cardiff Business School. He has published in a range of leading journals including, Journal of Business Venturing, Organisation Studies, Human Relations, Management Learning and Journal of Management Inquiry. He is also an Associate Editor for Organisation and consulting editor for the International Journal of Management Reviews. He is a Public Value Fellow at Cardiff Business School and works closely with Cardiff-based stakeholders to support the refugee community through positive action.

Keith Harding

Professor Keith Harding CBE FRCGP FRCP FRCS FLSW, Medical Director, has had a longstanding interest in wound healing. He was appointed as the first Director of the Wound Healing Research Unit in 1991. From September 2013 to December 2018 he was Dean of Clinical Innovation at Cardiff University. In 2014 he was appointed as Medical Director of the Welsh Wound Innovation Centre and in January 2021 was appointed as Senior Advisor for Clinical Innovation for Cardiff &Vale University Health Board. His clinical practice is exclusively focused on treating patients with wound healing problems with a wide range of aetiologies. He has held external professorial appointments at universities in the UK, Australia and Singapore. He has authored over 400 publications in the field of wound healing and has written a number of chapters and books in this area. He is the Editor-in-Chief of the International Wound Journal. He was awarded the CBE in the New Year Honours list in January 2013 for Services to Medicine and Health Care. In 2013 he was awarded £4.2 million to set up the Welsh Wound Innovation Initiative part of which has enabled the setting up of the first clinically focused Wound Healing Centre in the World. In 2014 he was awarded The Learned Society of Wales Fellowship. In 2018 he, with others, was awarded a £24 million European grant to establish a Clinical Innovation ecosystem across South Wales. In 2018 he was appointed as a Senior Clinical Research Director at the A Star Institute in Singapore and is part of a SG$28 million wound programme grant. In total he has been awarded around £200M of funding for work in wound healing and clinical innovation.