The results obtained using the concept mapping methodology have allowed us to identify different mechanisms and impacts by which the “Employment in the Neighbourhoods” ALMP can influence the quality of life of participants from the most deprived areas of Barcelona. The impacts identified were improved mental health and emotional wellbeing, including self-esteem and empowerment. Improvement on mental health has been also shown in a pre-post evaluation using quantitative methodology (26).
Some of the mechanisms identified for these improvements were in line with Jahoda’s theory (5); this is strengthened social networks especially among women and daily structure, activity and social identity especially among men. Here, it has to be highlighted that social identity, in the case of men, is manifested through the reactivation of their role as breadwinners. This sounds specific for Spanish social context, and was not previously found in any other study, and could be attributed to gender roles and the configuration of the family in Spain, which we will discuss later. In terms of increasing sense of control, according to Fryer’s theory (10), results show an increase of empowerment, self-esteem and confidence. One of the particularities of this study is that empowerment is manifested through increasing negotiation skills and the awareness of labour rights, a part from increasing technical skills which has been stated in other studies. Thus, increasing in negotiation skills and knowledge on rights at least among this population with low formal education and high prevalence of immigrants, could improve their sense of control, and thus, their mental health. Economic stability, as a material pathway, came into light, when subsidized employment was undergone. Subsidized employment embedded also a negative externality being their short-term duration.
Two other psychosocial mechanisms were highlighted among our population, that is, the improvement of their attitude to their families, and the feeling of accompaniment. Again, family is a key point for the wellbeing of unemployed people in our population. And a rather new psychosocial factor that is the need of feeling accompanied. One of the specific characteristics that differentiate “Employment in the Neighbourhoods” from other ALMPs, even in Barcelona, is the use of a personal guidance counsellor to accompany participants through the entire process. These results are in line with previous qualitative research, where the attitude of personnel was essential, and where participants felt strong support from staff (14), and that coaches were welcoming and non-judgmental (27), ideas that also appeared in our study. The reported consequences were not feeling alone, improved self-confidence and self-esteem, and increased optimism and joy (27). Social support has been suggested as an important health-protecting factor among the unemployed (28). “Employment in the Neighbourhoods” provided social support through both the technical staff’s support and a strengthened social network.
Gender differences
Gender differences regarding mechanisms were one of the particularities of our results. Authors decided to preserve the gender stratification during brainstorming sessions due to possible differences in communication patterns between genders. In mixed-gender public gatherings, men are known to spend more time talking than women and are more likely to interrupt, such that women generally have less confidence in their ability to make arguments. Moreover, due to the gender division of labour, still present to a lesser or greater extent in most societies, the mechanisms that link the intervention to health and well-being may differ between men and women. Women are still the main person responsible for care work in the private sphere, which sometimes changes their psychological needs for employment, most notably time structure and social identity or status. This could explain the gender differences regarding the impact of unemployment and ALMPs on health.
It is known that transitions from paid employment to unemployment have detrimental effects on mental health for both men and women (2). However, different health impacts have been observed according to 1) the degree that Welfare State and other country level policies and institutions promote traditional gender roles and 2) the degree of individual performativity of dominant gender roles. At state level, it has been shown that those countries that promote greater gender equality, the impact of unemployment on health is similar for men and women (2). In Spain, a Southern country implementing traditional family policies, we have observed that among married individuals, unemployment has a worse impact among men, due to their traditional role as breadwinners. However, married women with no nurturing roles in non-manual classes had worse health compared with their manual-class counterparts (29). Among single individuals, unemployment’s impact is similar for men and women, except for single mothers which is worst (2).
Less is in known regarding the gender differential effects of ALMPs on health. One of the few studies we found showed that in UK, through a cross-sectional study, life worth and happiness of male ALMP participants was higher than unemployed, and among female the effect of participation on life satisfaction was fairly strong (4). Rojdalen et al. (30) also designed a non-experimental quantitative study based on retrospective judgments in Sweden taking into account gender differences. Those who most judged that mental health was affected positively as a result of training were women, and the less well-educated. Yet neither of the two studies provided a sociological reflection on the mechanisms. A qualitative research among women in East London (31), where most programs are compulsory, demonstrated that due to the temporary nature of the programmes, participants experienced feelings of insecurity, financial strain, role conflicts and concerns about non maternal childcare. Mothers felt responsible for leaving their children during the training.
In a quantitative study we showed that “Employment in the Neighbourhoods” improved mental health in both men and women (26). The present study shows different gender mechanisms explaining this improvement. Women relate their improvement to the ability of the program to reactivate their social network, as well as the increase of self-esteem and confidence through the learning process, and their feeling of accompaniment and protection through the technical staff. Although, they also relate the further health disadvantages of entering the labour market, given the health impacts that may arise from entering precarious employment, especially long working hours, which could enter in conflict with family responsibilities. On the other hand, men relate their improvement to the ability of finding a job. Economic stability is recognized as one of the most important pillars for men’s well-being, and they highlight their job as a source of identity. This brings us back to the role of breadwinner. No less important is the fact that both men and women relate how the ALMP generate changes in their family relationship. This makes us reflect on how important it is that ALMPs in this specific context are designed taking into account not only the individual but also the relationship with the family to be more effective, at least in terms of quality of life.
Labour market situation
In some circumstances programs that promote reemployment are not feasible, either because of a lack of jobs due to economic conditions or lack of skills in specific disadvantaged populations. The Spanish labour market is characterized by persistent high unemployment and precarious employment conditions, including more temporary work, low salaries, vulnerability, and inability to exercise rights (32). Labour market reforms implemented during the last years of the current economic recession have worsened this situation, increasing social inequality. Immigrants and manual and poorly-educated workers, as well as women and young people, are overrepresented in the most precarious jobs (33), and these groups are the target population of “Employment in the Neighbourhoods”. In this scenario, some negative emotions of frustration and discouragement emerged from the program when participants were not reemployed, or reemployed in precarious jobs. These negative emotions emerged as a specific cluster in both the technical staff and participants groups, and were more important in the latter. In addition, finding a job in precarious employment improves wellbeing at first, but this is disrupted by the reality of precarious labour market conditions, or at the end of the 6–month term of jobs subsidized by the program. In this sense, one of the participants’ specific demands was the need to continue the program and maintain the counsellor or person of reference after completing the insertion itinerary.
Considering labour market characteristics and health and wellbeing, we need to reflect on the notion that “any job is better than no job” (5). The simplistic dichotomy between employment and unemployment is rather more complex than viewing unemployment as “bad” and employment as “good”. This is particularly pertinent given evidence that the labour market is often dominated by low pay and limited sustainability, such that reemployment in a precarious position could be more detrimental for health and quality of life (34). Thus, a comprehensive program for unemployed individuals including economic benefits and activities to reintroduce participants into the labour market is needed. A comprehensive program could trigger both material and psychosocial mechanisms to cushion the effects of unemployment. These measures should be accompanied by policies to improve job quality.
Strengths and limitations
One of the strengths of this study was the use of concept mapping for evaluation. Compared to quantitative methodologies, concept mapping can identify various mechanisms, allowing us to evaluate complex interventions. This methodology has allowed us to discover both positive aspects of the program, which could be reinforced, as well as negative aspects, some of which are contextual problems, while others could be addressed partially. Moreover, maps are easy to read and interpret by decision-makers and the general public. The study also introduces the double perspective of professionals and participants, which enriches the analysis, and as explained above, it highlights gender differences.
Besides, to our knowledge, this is one of the few health-related evaluations of ALMPs in Spain, and in South European in general. Thus, our study is an important contribution because, compared to Northern Europe, South European countries have different welfare systems and different gender and family regimes. As we have seen, this fact has important implications regarding mechanisms.
This study also has some limitations, the most important being the participants’ difficulty in understanding due to formal educational background or being non-native speakers of Spanish or Catalan. Although this was not problematic for the brainstorming session, it was the main drawback during the rating and sorting session, in that some participants were not able to sort the statements with respect to their similarity to some overarching concept. This is reflected in the cluster map, in that the distance between statements in each cluster are longer in the participants’ map, making it more difficult to choose a final map. For the same reason, the research team decided to name the clusters in the participants’ map, and not to conduct the final session to interpret the maps. As a consequence, researchers carried out the interpretation stage, which could influence results. The role of the researcher should be a mere facilitator of the methodology. To ensure internal validity, the interpretation was triangulated by several of the principal investigators and agreement was reached on the final solution.
On the other hand, the participants showed extremely rich generation of ideas, most of which were common with the technical staff’s perceptions. The brainstorming sessions highlighted important differences between the discourses of men and women, although this was difficult to visualize in the sorting session, probably because of difficulty in reading comprehension and skills for conceptualizing. Moreover, due to their background of long-term unemployment, some had participated in previous ALMPs and had difficulty in identifying and isolating the specific effects of the “Employment in the Neighbourhoods” program. The technical staff’s three sessions worked well, although this group had fewer participants (9) than recommended for this methodology (15) (22).
Regarding external validity, this study may not be representative for the entire population participating in “Employment in the Neighbourhoods”. The aim of the technique is to approach the maximum discursive variability to ensure that different conceptual meanings are collected. To accomplish this aim we conducted a theoretical sampling and ensured that socio-demographic characteristics were similar to the entire population. Moreover, we did two different concept mappings, one with participants and the other with professionals and results were very similar, as discussed. However, a more fully concept to increase external validity might be achieved by repeating the same procedure several times, in different years and with different groups. It should be noted that, after conducting the four groups of ALMP’s participants, saturation of discourse was reached.
Final remarks
The impact of ALMPs in relation to their costs is often questioned. Of course, the criteria for success of an ALMP depend on the theoretical perspective the evaluations are based on. These criteria could be the degree of participation in activation programmes, which would increase participants’ chances of reemployment (35). From a public health perspective, and from a “health in all policies” approach (36), improved health and wellbeing should also be one of the criteria for success. There is generally limited scientific evidence in this field, especially in relation to labour market policy-makers approach to include health and wellbeing as a measure of the success of ALMPs. Clearly, there is a societal benefit to evaluating programs and policies, not purely in economic terms, but in terms of health and wellbeing.