Local government interventions for improving the health and wellbeing of tenants in private rented housing: developing initial program theory to inform evaluation in the United Kingdom

Rachael McClatchey; Claire F Ferraro; Ellis Turner; Jennifer Harris; Jonathan Banks

doi:10.1186/s12889-024-19163-9

Local government interventions for improving the health and wellbeing of tenants in private rented housing: developing initial program theory to inform evaluation in the United Kingdom

BMC Public Health. 2024 Aug 7;24(1):2144. doi: 10.1186/s12889-024-19163-9.

Authors

Rachael McClatchey^{1

2

3}, Claire F Ferraro^{4

5}, Ellis Turner¹, Jennifer Harris⁶, Jonathan Banks^{7

8}

Affiliations

¹ School of Health and Social Wellbeing, University of the West of England, Coldharbour Lane, Stoke Gifford, Bristol, BS16 1QY, UK.
² Office for Health Improvement and Disparities, Department for Health and Social Care, Temple Quay, 2 Rivergate, Bristol, BS1 6EH, UK.
³ School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.
⁴ Office for Health Improvement and Disparities, Department for Health and Social Care, Temple Quay, 2 Rivergate, Bristol, BS1 6EH, UK. claire.ferraro@nhs.net.
⁵ National Public Health Speciality Training Programme, South West, Bristol, UK. claire.ferraro@nhs.net.
⁶ Tenancy Deposit Scheme, First Floor, West WingThe Maylands Building, 200 Maylands Avenue, Hemel Hempstead, Hertfordshire, HP2 7TG, UK.
⁷ Applied Research Collaborative West, National Institute for Health and Care Research, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, BS21 2NT, UK.
⁸ Bristol Medical School, Population Health Science, University of Bristol, Bristol, BS8 1QU, UK.

Abstract

Background: Housing is an important wider determinant of health. Private Rented Sector (PRS) housing is generally the worst quality of housing stock across tenures. Although a wide range of interventions are available to local governments to manage and improve the quality of PRS housing and therefore the health of tenants, there is limited evidence about the extent to which these are used. This study aims to explore what drives the use of different interventions in different local governments, to better understand and inform local strategies.

Methods: As the first realist evaluation on this topic, the range of available interventions was informed by a Local Government Association toolkit. Consistent with realist approaches, retroductive analysis of intervention-context-mechanism-outcome configurations helped to develop and refine Initial Programme Theories (IPTs). Data sources included local government housing documents, a survey and eleven semi-structured interviews with housing officers.

Results: Using data for 22 out of the 30 local governments in the South West region of the United Kingdom, eight IPTs were developed which act on different levels from individual PRS team leaders to system wide. The IPTs include a belief in market forces, risk adverse to legal challenge, attitude to enforcement, relational approaches to partnership working, job security and renumeration, financial incentives drive action, and system-level understanding of the drivers of poor health, inequalities and opportunities for cost-savings. The findings suggest that limited objective health outcomes are being used to understand impact, which hinders interpretation of the effectiveness of all mechanisms.

Conclusion: Interventions that bring about positive outcomes in managing PRS housing are unlikely to be universal; they depend on the context which differs across place and over time. The proposed IPTs highlight the need for strategies to be tailored considering the local context and should be evaluated in subsequent phases of study.

Keywords: Causal mechanisms; Local Government; Private Rented Housing; Public health; Realist evaluation.

MeSH terms

Housing* / standards
Humans
Local Government*
Private Sector
Program Evaluation
United Kingdom