The adverse health effects of living in under resourced neighborhoods has been well documented. While structural factors, such as concentrated poverty, have received the most investigation, research points to neighborhood social dynamics as a potential mechanism that influences health. Collective efficacy is one such social dynamic considered for its association with individual health outcomes. Collective efficacy refers to the social cohesion among residents and shared expectations that residents will come together for the good of the neighborhood. As the link between neighborhoods and health has become more established, place-based strategies are being employed to improve the health status of residents living in under-resourced neighborhoods. Collective efficacy’s unique feature of mobilizing residents to achieve neighborhood goals may be an important component of neighborhood quality and opportunity for neighborhood change.

Much of the empirical evidence on collective efficacy comes from cross-sectional studies, therefore we do not know if collective efficacy can change and whether this change leads to improved health. In addition, we lack an understanding of how community change initiatives are attempting to promote and enhance collective efficacy as a strategy to mobilize residents toward community change. This dissertation aims to address these gaps in knowledge.

This dissertation uses multiple methods to deepen our understanding of the role of neighborhood collective efficacy on the health and well-being of residents. The first paper is a systematic, interdisciplinary review of the literature on collective efficacy and health and is one of the first to synthesize this literature. The review aims to assess the evidence of a link between collective efficacy and health, and to provide areas for future research. The second paper is a multi-level longitudinal analysis exploring whether collective efficacy changes over time in low income communities in seven U.S. cities. This paper takes advantage of a unique data set from the Annie E Casey Foundation’s Making Connections Initiative that surveyed residents across three waves over eight years. The third paper explores how community change initiatives are promoting collective efficacy among residents in their target neighborhoods, and how residents experience this work. The research employs a case study approach with semi structured interviews and observations to illuminate the role of collective efficacy as a strategy to promote neighborhood change.