CROSS-CUTTING CASE STUDY ANALYSIS
The cross-cutting analysis reveals shared properties of the health capability profiles and flow diagrams.
UNIQUE, RICH, AND DYNAMIC PROFILES OF INTERDEPENDENT HEALTH CAPABILITIES
First, each profile is unique to each individual’s case study. This is partly because external capabilities are assessed within the context of individuals’ unique lived experiences: G experiences optimal group membership and social capital, whereas V exhibits significant shortfalls in this health capability. Yet, they could be living in the same town or state—an illustration of how similar local circumstances may differentially affect individuals, which traditional health policy analyses would miss. Additionally, the profile is unique to the given timeframe in the individual’s narrative: for instance, G’s knowledge was low before he was diagnosed with diabetes; however, it is now optimal in his current diagram, as he has become knowledgeable in understanding and managing his condition. The HCP’s ability to capture specific timeframes and track progress over time is essential to reflect people’s evolving skills and changing conditions.
Second, a key advantage of the HCP is its richness in offering several interdependent levels of analysis for each individual profile. The flow diagrams present the distribution of health capabilities according to their development levels (from shortfall to optimal), thereby revealing an overall vulnerability (e.g., in T’s case of discriminatory fat-shaming social norms harming enabling healthcare and inclusive public spaces) or strength (e.g., in O’s case of supportive group membership and social capital helping her navigate and pay for her healthcare). In addition, the profile allows for a single health capability to have both positive and negative influences on an individual’s ability to achieve wellbeing. For instance, ‘health care systems’ were both detrimental due to the early misdiagnosis of H’s condition and enabling in currently providing excellent care for his now identified chronic kidney disease.
Third, the profile is intrinsically dynamic. It illuminates beneficial cycles of cumulative skills-building—as illustrated by H’s skills-building supported by family, friends, and healthcare workers, as well as harmful cycles of multidimensional vulnerability, such as V’s abusive childhood, traumatic experiences afterwards, and resulting mental health issues. The profile’s dynamic nature enables users to distinguish between development levels for each health capability from their influences on other capabilities. Highly developed capabilities themselves do not necessarily always positively influence other capabilities; rather, the HCP demonstrates that they can also be inhibiting. This allows more nuanced analysis of the complex and careful balance among health capabilities needed and reveals seemingly counterintuitive phenomena of optimal yet impeding conditions, as well as arduous yet enabling conditions. For instance, N’s privileged background (i.e., optimal material circumstances) partly enabled her substance use disorder and hindered her development of effective self-management, self-governance, and decision-making skills.
The Health Capability Profile can be applied to all case studies that we analyzed, across both physical and mental health conditions, as well as different settings (e.g., urban and rural; low- and high-income communities). Overall, the profile stresses the complex and heterogeneous effects of health capabilities. Moreover, the profile is particularly helpful to understand and address mental health issues by integrating mental health status and psychosocial wellbeing as important elements of health capabilities’ dynamic development and interactions.
A flexible framework illuminating common challenges
Despite the uniqueness of each individual case study, the HCP reveals common vulnerabilities across their profiles: similar shortfalls in health capabilities and interactions among them, thereby prompting similar behavioral, programmatic, and policy changes. Displayed in the table below, these results demonstrate the third and last step of applying the profile: examining observed shortfalls and designing targeted recommendations.
Through its proactive and preventative orientation, the HCP further identifies positive examples, which illuminate what works—or what would work under optimal but realistic conditions. This enables researchers and practitioners to identify which elements or combination are enabling or inhibiting, thereby narrowing the leverage points that policymakers, individuals, and communities should prioritize. Finally, the HCP offers a valuable tool for clinicians, healthcare professionals, and social workers to generalize case management approaches, and for individuals themselves to analyze, track, and promote their own health capabilities’ development.