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Paper short abstract

This paper examines how local care actors in two Dutch neighborhoods learn to navigate tensions between institutional and community logics. Drawing on action research, it shows how relational learning processes help sustain and reshape neighborhood care infrastructures.

Paper long abstract

In high-income countries such as the Netherlands, health systems rooted in biomedical models are increasingly reaching their limits as they struggle to address broader social determinants shaping population well-being. At the neighborhood level, local actors with both formal and informal care roles often address these social determinants while navigating tensions with institutions organized around different logics of care and accountability. In doing so, they are continuously learning from and adapting to the local context, their collective practices both sustaining and transforming local care infrastructures. Drawing on action research conducted in two Dutch neighborhoods, including ethnographic methods, interviews, and living labs, this paper examines these continuous learning processes.

Specifically, the study shows how local care actors enact learning processes to navigate tensions between institutional and community logics surrounding roles, time, and space. We show that tensions are experienced between formal mandates and context-responsive, often unpaid roles; between institutional time structured by budgets, timelines and accountability frameworks and the relational rhythms of care; and between administrative boundaries of what a neighborhood is and the fluid understandings of community. In response, actors identify, balance and question these tensions, coordinate across them through dialogue and translation practices, reflect individually and collectively to make implicit assumptions explicit, and at times actively transform relationships, roles, and care practices. These learning processes are relational and occur both during planned learning activities and everyday interactions. Their capacity to influence local care infrastructures depends on the forms of legitimacy that actors can mobilize within both formal and informal contexts.