Evaluating complex community-based health promotion: Addressing the challenges

Author version made available in accordance with the publisher's policy. NOTICE: this is the author’s version of a work that was accepted for publication in Evaluation and Program Planning. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in EVALUATION AND PROGRAM PLANNING, 45, (August 2014) DOI 10.1016/j.evalprogplan.2014.03.006.Community-based health promotion is poorly theorised and lacks an agreed evidence-base. This paper examines characteristics of community-based health promotion and the challenges they present to evaluation. A review of health promotion evaluation leads to an exploration of more recent approaches, drawing on ideas from complexity theory and developmental evaluation. A reflexive analysis of three program evaluations previously undertaken as an evaluation consultant is used to develop a conceptual model to help in the design and conduct of health promotion evaluation. The model is further explored by applying it retrospectively to one evaluation. Findings suggest that the context-contingent nature of health promotion programs; turbulence in the community context and players; multiple stakeholders, goals and strategies; and uncertainty of outcomes all contribute to the complexity of interventions. Bringing together insights from developmental evaluation and complexity theory can help to address some evaluation challenges. The proposed model emphasises recognising and responding to changing contexts and emerging outcomes, providing rapid feedback and facilitating reflexive practice. This will enable the evaluator to gain a better understanding of the influence of context and other implementation factors in a complex setting. Use of the model should contribute to building cumulative evidence and knowledge in order to identify the principles of health promotion effectiveness that may be transferable to new situations. Key words Health promotion; evaluation; complexity; setting

Public health nutrition: identifying models and effective approaches to workforce development.

This literature review has drawn on published literature, reports and expert knowledge to identify models and effective approaches to workforce development for the nutrition, primary health care and other relevant non-health sector workforces. The review next illustrates the three approaches to workforce development using case study examples, and it discusses the lessons for public health nutrition workforce development

Australia’s systems of primary healthcare: The need for improved coordination and implications for Medicare Locals

Copyright © 2011 Royal Australian College of General Practitioners. Published version of the paper reproduced here with permission from the publisher.Background In Australia, primary healthcare is largely delivered through two parallel systems: Medicare supported primary care delivered by fee-for-service general practitioners, and state funded and managed community health services. Methods Semistructured interviews with 18 GPs to investigate the current links between GPs and local primary healthcare providers. Results Barriers to links include: communication and information, access and availability of services, GP lack of awareness and understanding of services provided in the state funded sector, and lack of time to gain information. Discussion General practitioners reported dealing with more complex and challenging patients. However, this did not appear to increase their likelihood of engaging with state funded primary healthcare services in case management. Medicare Locals are a once-in-a-generation chance to establish a genuinely coordinated and multidisciplinary primary healthcare sector. To be successful, Medicare Locals will need to bring together two parallel systems of care and improve integration and coordination

Positive and negative impacts of job loss on family life: the perceptions of Australian car workers

This article contributes to research on the impact of job loss on families. It is based on survey responses from 371 workers and in‑depth interviews with 39 of them about the family impacts of their job loss from the Mitsubishi car factory in Adelaide in 2004‑2005. A majority of workers said family life had been affected by their job loss. Quantitative analysis identified four variables significantly associated with family impacts: marital status, children living at home, employment status and financial management. Qualitative responses showed the predominantly negative impacts were financial strain, loss of relationship stability, and general stress and worry, although few faced catastrophic impacts from their job loss. However, in contrast to most previous research, the in‑depth interviews also revealed positive impacts from job loss, such as having more time at home and to spend with their family. We conclude that the existence of ongoing income support and public health insurance in Australia were important in avoiding catastrophic financial impacts on these workers and their families.The authors acknowledge support from the National Health and Medical Research Council Capacity Building Grant (324724). The research was also supported by the SA Department of Health and the SA Department of Families and Communities through the Human Services Research and Innovation Program (HSRIP), and the Australian Research Council Linkage Program (LP0562288), with the Department of Health serving as Industry Partner. Professor Fran Baum was supported by an ARC Federation Fellowship and Drs Newman and Ziersch by the SA Premier’s Science and Research Fund

Transformational change in health systems: a road strewn with obstacles.

This research study assesses the impact on primary health care of the reform changes in the South Australian health system from 2005 to 2007. The research follows a pilot study conducted in one of the newly created health regions in 2005 to 2006 and reported in: Governance change in the southern metropolitan Adelaide health region: implications for Primary Health Care (Baum et al. 2006). Both studies were intended as scoping exercises to contribute towards the development of an evaluation framework for primary health care

Evaluating the effectiveness of comprehensive primary health care in local communities: how do general practitioners work with and perceive primary health care services directly funded by government. Report to SA Health.

The South Australian Community Health Research Unit (SACHRU), Flinders University, was contracted by SA Health in 2009-2010 to conduct the study 'Evaluating the effectiveness of comprehensive primary health care in local communities: how do general practitioners work with and perceive primary health care services directly funded by government'. This research study focuses on the links between primary health care (PHC) services directly funded and managed by government and services provided by general practitioners (GPs). It complements research funded under an NH&MRC project grant that is examining evaluation of comprehensive primary health care (CPHC) by working with five PHC service sites in South Australia and one service in Alice Springs

Developing a good practice model to evaluate the effectiveness of comprehensive primary health care in local communities

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedBackground: This paper describes the development of a model of Comprehensive Primary Health Care (CPHC) applicable to the Australian context. CPHC holds promise as an effective model of health system organization able to improve population health and increase health equity. However, there is little literature that describes and evaluates CPHC as a whole, with most evaluation focusing on specific programs. The lack of a consensus on what constitutes CPHC, and the complex and context-sensitive nature of CPHC are all barriers to evaluation. Methods: The research was undertaken in partnership with six Australian primary health care services: four state government funded and managed services, one sexual health non-government organization, and one Aboriginal community controlled health service. A draft model was crafted combining program logic and theory-based approaches, drawing on relevant literature, 68 interview s with primary health care se rvice staff, and researcher experience. The model was then refined through an iterative process involving two to three workshops at each of the six participating primary health care services, engaging health service staff, regional health executives and central health department staff. Results: The resultant Southgate Model of CPHC in Australia model articulates the theory of change of how and why CPHC service components and activities, based on t he theory, evidence and values which underpin a CPHC approach, are likely to lead to indivi dual and population health outcome s and increased health equity. The model captures the importance of context, the mechanisms of CPHC, and the space for action services have to work within. The process of development engendered and supported collaborati ve relationships between researchers and stakeholders and the product provide d a description of CPHC as a whole and a framework for evaluation. The model was endorsed at a research symposium involving inv estigators, service staff, and key stakeholders. Conclusions: The development of a theory-based program logi c model provided a framework for evaluation that allows the tracking of progress towards desired outcomes and exploration of the particular aspects of context and mechanisms that produce outcomes. This is important because there are no existing models which enable the evaluation of CPHC services in their entirety

Governance change in the southern metropolitan Adelaide health region: implications for Primary Health Care.

This report describes a study aiming to assess the impact of the introduction of regional health structures to metropolitan Adelaide. The study was conducted in 2005 in the southern Adelaide region. Major research questions were: What is the most effective way to organise health service governance in order to promote and strengthen primary health care as a key focus of the health system? How does a change in health service governance affect the position of primary health care in relation to acute care services

The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints

The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia.This study was funded by an NH&MRC Project Grant 535041 and FB’s time is funded by an ARC Federation Fellowship. RL is funded by the Canada Research Chair program

Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners

This is the accepted version of the following article: [Freeman, T., Edwards, T., Baum, F., Lawless, A., Jolley, G., Javanparast, S. and Francis, T. (2014), Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Australian and New Zealand Journal of Public Health, 38: 355–361. ], which has been published in final form at doi: 10.1111/1753-6405.12231. This item was under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy.Objective. There is little literature on health service level strategies for culturally respectful care to Aboriginal and Torres Strait Islander Australians. We conducted two case studies: , one Aboriginal community controlled, and one state government managed primary health care service to examine cultural respect strategies, client experiences, and barriers to cultural respect. Methods. Data were drawn from 22 interviews with staff from both services, and four community assessment workshops, with a total of 21 clients. Results. Staff and clients at both services reported positive appraisals of the achievement of cultural respects. Strategies included being grounded in a social view of health, including advocacy and addressing social determinants, employing Aboriginal staff, creating a welcoming service, supporting access through transport, outreach, and walk-in centres, and integrating cultural protocol. Barriers included communication difficulties, racism and discrimination, and externally developed programs. Conclusions. Service level strategies were necessary to achieving cultural respect. These strategies have the potential to improve Aboriginal and Torres Strait Islander health and wellbeing. Implications. Primary health care’s social determinants of health mandate, the community controlled model, and the development of the Aboriginal and Torres Strait Islander health workforce need to be supported to ensure a culturally respectful health system