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Open Access Study protocol

Social cohesion through football: a quasi-experimental mixed methods design to evaluate a complex health promotion program

Sally Nathan1*, Anne Bunde-Birouste2, Clifton Evers3, Lynn Kemp4, Julie MacKenzie5 and Robert Henley6

Author Affiliations

1 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia

2 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia

3 International Communications Department, University of Nottingham, Ningbo, China

4 Centre for Primary Heath Care and Equity, University of New South Wales, Sydney, Australia

5 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia

6 San Carlos Apache Tribe Wellness Center, San Carlos, USA

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BMC Public Health 2010, 10:587  doi:10.1186/1471-2458-10-587

Published: 5 October 2010


Social isolation and disengagement fragments local communities. Evidence indicates that refugee families are highly vulnerable to social isolation in their countries of resettlement. Research to identify approaches to best address this is needed. Football United is a program that aims to foster social inclusion and cohesion in areas with high refugee settlement in New South Wales, Australia, through skills and leadership development, mentoring, and the creation of links with local community and corporate leaders and organisations. The Social Cohesion through Football study's broad goal is to examine the implementation of a complex health promotion program, and to analyse the processes involved in program implementation. The study will consider program impact on individual health and wellbeing, social inclusion and cohesion, as well as analyse how the program by necessity interacts and adapts to context during implementation, a concept we refer to as plasticity. The proposed study will be the first prospective cohort impact study to our knowledge to assess the impact of a comprehensive integrated program using football as a vehicle for fostering social inclusion and cohesion in communities with high refugee settlement.


A quasi-experimental cohort study design with treatment partitioning involving four study sites. The study employs a 'dose response' model, comparing those with no involvement in the Football United program with those with lower or higher levels of participation. A range of qualitative and quantitative measures will be used in the study. Study participants' emotional well being, resilience, ethnic identity and other group orientation, feelings of social inclusion and belonging will be measured using a survey instrument complemented by relevant data drawn from in-depth interviews, self reporting measures and participant observation. The views of key informants from the program and the wider community will also be solicited.


The complexity of the Football United program poses challenges for measurement, and requires the study design to be responsive to the dynamic nature of the program and context. Assessment of change is needed at multiple levels, drawing on mixed methods and multidisciplinary approaches in implementation and evaluation. Attention to these challenges has underpinned the design and methods in the Social Cohesion through Football study, which will use a unique and innovative combination of measures that have not been applied together previously in social inclusion/cohesion and sport and social inclusion/cohesion program research.