UPWEB

Understanding the Practice and Developing the Concept of Welfare Bricolage

This project will reconceptualise welfare theory through responding to the question of how all residents living in superdiverse neighbourhoods access healthcare. Such a focus is pertinent given increasing population complexity, heterogeneity and pace of change under globalisation, and the subsequent need to rethink welfare design, alongside issues of engagement, approachability and effectiveness. Using innovative techniques including street-mapping, community research and a mobile phone “app” alongside a neighbourhood survey, we explore the multiple approaches that residents living in superdiverse neighbourhoods use to meet their health needs, encompassing the perspectives of service users and providers. We will generate new theoretical and practical insights through the development of models of welfare bricolage: the practice by which individuals combine formal, informal and virtual health services across public, private and third sectors in an attempt to meet need. We use a comparative/sequential approach to interrogate local welfare states across eight deprived and upwardly mobile superdiverse neighbourhoods in four different national welfare states (UK, Portugal, Germany and Sweden) each with different welfare, health and migration regimes. By focussing on key features of superdiverse neighbourhoods where residents are differentiated according to faith, income (including socio-economic status), age, gender and legal status, we bring new insights with societal, practical and policy relevance. The study will illuminate inequalities and diversity in respect of individuals’  relationship with healthcare, different modes of provision, and responsibilities for welfare allocation.

Project Summary

Objectives

  • To examine the experiences of residents of superdiverse neighbourhoods in accessing services for their health concerns, including formal and informal sources of advice, treatment and support.
  • Ethnographic street mapping and interviews with a diversity sample of adult residents in Gottsunda and Sävja.
  • To investigate the influences on residents’ access to healthcare, looking locally, nationally and transnationally.
  • Analysis of interviews with residents and with neighbourhood service providers, in combination with survey results.
  • To explore how different service providers identify and meet the healthcare needs of neighbourhood residents.
  • Analysis of service provider interviews in light of resident interviews and survey results.
  • Drawing on the qualitative and quantitative findings to describe new models of service provision suitable for diverse and mobile neighbourhoods.

Main Results

  • Identification of a range of formal and informal sources of support and treatment and a bricolage typology whereby patterns of residents usage across public healthcare, private and alternative services are identifiable.
  • Identification of bricolage typology among service providers and differential levels of bricolage across the four countries.
  • Identification of common (and longstanding) lack of good quality healthcare interpretation, hindering access across all four countries.
  • Description of an enhanced model for superdiverse locality-based healthcare access
  • Exploration of constrained meanings of gratitude for services, expressed by vulnerable women of migrant background
  • Description of trans-global healthcare seeking patterns.

Impact and use

The findings have described the complexity of healthcare seeking in neighbourhoods characterised by migration-driven diversity. The project coincided with the ‘migration crisis’ of 2015-16 when around 163,000 refugees arrived in Sweden, with welfare and healthcare services stretched in meeting increased demands. The evidence from our project has been very timely in filling in the picture of the strategies and tactics adopted by neighbourhood populations made up of new arrivals, longer standing and resident populations and how these needs are met by providers. Our findings have made visible unofficial work undertaken by patients and professionals that is not accounted for. This is important in understanding the particular demands and opportunities that diverse neighbourhoods represent.