Maintaining evaluation designs in long term community based health promotion programmes: Heartbeat Wales case study.

STUDY OBJECTIVE--To examine the difficulties of developing and maintaining outcome evaluation designs in long term, community based health promotion programmes. DESIGN--Semistructured interviews of health promotion managers. SETTING--Wales and two reference health regions in England. PARTICIPANTS--Nine health promotion managers in Wales and 18 in England. MEASUREMENTS AND MAIN RESULTS--Information on selected heart health promotion activity undertaken or coordinated by health authorities from 1985-90 was collected. The Heartbeat Wales coronary heart disease prevention programme was set up in 1985, and a research and evaluation strategy was established to complement the intervention. A substantial increase in the budget occurred over the period. In the reference health regions in England this initiative was noted and rapidly taken up, thus compromising their use as control areas. CONCLUSION--Information on large scale, community based health promotion programmes can disseminate quickly and interfere with classic intervention/evaluation control designs through contamination. Alternative experimental designs for assessing the effectiveness of long term intervention programmes need to be considered. These should not rely solely on the use of reference populations, but should balance the measurement of outcome with an assessment of the process of change in communities. The development and use of intervention exposure measures together with well structured and comprehensive process evaluation in both the intervention and reference areas is recommended

A Formative Evaluation of the Welsh Heartbeat Award Scheme

This paper presents findings from a study which examined the experiences of Environmental Health Officers and catering establishments with the Welsh Heartbeat Award Scheme, and their views on its future direction. Data were obtained via self-completion questionnaires from 26 Environmental Health Officers and 117 catering establishments across Wales between November 1991 and May 1992. The results show that the scheme is valued by both groups. Suggested improvements included leaflets to promote the scheme to caterers, and hygiene guidance notes and a healthy catering recipe book for caterers. One key problem highlighted by the study was effective monitoring of the scheme, a solution to which may lie with District Health Authority commissioners