Assessing partnership working: Evidence from the National Sexual Health Demonstration Project

Partnership working has become something of a government imperative for tackling complex public health issues and is now more often the norm than the exception in health education and disease prevention work. The literature however, highlights that partnership working may be explained more by rhetorical appeal rather than any concrete evidence of effectiveness. There is little evidence from the literature examining the functioning, effectiveness or outcomes of partnership for health improvement. Partnership working was used within one such public health initiative (Healthy Respect) as a means of implementing and delivering a complex sexual health intervention programme to young people aged 10-18 years in Lothian. The main aim of Healthy Respect was to create an environment that would lead to long term improvements in the sexual health and wellbeing of young people through a multi-faceted approach which linked to education, information and services. This PhD study aimed to assess the extent and impact of partnership working in the Healthy Respect project; it aimed to examine the process and outcomes of partnership working for the organisations involved in the programme and to theoretically assess how this may impact on improving young people’s sexual health and wellbeing. The study used Healthy Respect’s logic model as a framework to examine the theory of how change occurred through partnership working in the project. A mixed method research design was used consisting of two postal surveys and in depth interviews with a sample of providers delivering sexual health education, information and services to young people in Lothian.Results suggest that Healthy Respect was only partially successful in working in partnership with some of the organisations involved in delivering sexual health education, information and services to young people. Partnerships were formed with approximately half of the providers. Those most engaged and working in partnership with Healthy Respect were from the NHS (including school nurses) and voluntary organisations which offered sexual health services to young people. Sexual health services also occupied a dominant position in the local networks of providers. Many providers linked with these services including secondary schools which offered Sexual Health and Relationship Education (SHARE). Other organisations most notably those from the Local Authority organisations were less willing to work in partnership with Healthy Respect. Many of the barriers (identified through the qualitative interviews with providers) to working in partnership with Healthy Respect came mostly from the Local Authority organisations and offered an explanation as to why partnerships with these organisations didn’t develop as planned. Results did suggest that where partnership work was taking place, this impacted on an organisations ability to deliver sexual health information, education and services to young people. However, partnerships with Healthy Respect were only formed with approximately 46% of the providers targeted, therefore not all organisations and subsequently young people would have benefitted from the Healthy Respect programme. The Healthy Respect programme was heavily reliant on partnership working to deliver the complex intervention. Yet results suggest that they were only partially effective in working in partnership with the organisations involved which may have led to them having little impact on the sexual health and wellbeing of young people (especially the most vulnerable). Partnerships take a long time to build and require a great deal of time and resources to be invested in them to work. However, the results of the study leave us with the fundamental question of whether all this time and effort should be applied to partnership working and interventions of this type for what could be very little impact on young people’s sexual health? This study has contributed to knowledge in the area of partnership working for health improvement. It defined what partnership was using a range of methods which moved beyond supportive attitudes and was able to examine and measure both the process and outcomes of partnership work in this project, something which few studies have been able to achieve

Assessing partnership working : evidence from the National Sexual Health Demonstration Project

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Understanding complex interactions using social network analysis

Aims and objectives. The aim of this paper is to raise the awareness of social network analysis as a method to facilitate research in nursing research.Background. The application of social network analysis in assessing network properties has allowed greater insight to be gained in many areas including sociology, politics, business organisation and health care. However, the use of social networks in nursing has not received sufficient attention.Design. Review of literature and illustration of the application of the method of social network analysis using researchexamples.Methods. First, the value of social networks will be discussed. Then by using illustrative examples, the value of social network analysis to nursing will be demonstrated.Results. The method of social network analysis is found to give greater insights into social situations involving interactionsbetween individuals and has particular application to the study of interactions between nurses and between nurses and patients and other actors.Conclusion. Social networks are systems in which people interact. Two quantitative techniques help our understanding of these networks. The first is visualisation of the network. The second is centrality. Individuals with high centrality are key communicators in a network. Relevance to clinical practice. Applying social network analysis to nursing provides a simple method that helps gain an understanding of human interaction and how this might influence various health outcomes. It allows influential individuals (actors) to be identified. Their influence on the formation of social norms and communication can determine the extent to whichnew interventions or ways of thinking are accepted by a group. Thus, working with key individuals in a network could be critical to the success and sustainability of an intervention. Social network analysis can also help to assess the effectiveness of such interventions for the recipient and the service provider.

Partnership working and improved service delivery: views of staff providing sexual health services

Objectives Successful partnership working has theoretically been linked to improvements in service delivery and is dependent on the strength of the partnership, trust, communication, professional roles and resource sharing. Empirical evidence to confirm the relationships between these factors and improved service provision, however, is lacking. Our aim was to assess the views of staff as to the conditions required for partnership working. Methods This study was a cross-sectional survey of 687 staff offering sexual health education, information or support to young people in the Healthy Respect intervention area in Scotland. Views of each variable were scored and structural equation modelling was used to assess the theoretical model. Results Responses were received from 284 (41%) staff. Greater strength of partnership was directly associated with increasing the number of referrals. Establishing professional roles between organizations was also associated with increasing the number of referrals. Strength of partnership was indirectly associated with working more effectively with young people and this relationship depended on clear communication, trust, established professional roles and shared resources. Effective partnership working depends on a number of interdependent relationships between organizations, which act synergistically to improve organizational outcomes. Conclusions Effective partnership working leads to improved service delivery though there is a need for better controlled studies which demonstrate the effect on health outcomes

Study of the implmentation of a new community health nurse role in Scotland.

In 2006 the Scottish Executive began a radical and far reaching Review of Nursing in the Community (RONIC). This review proposed the absorption of district nursing, health visiting, school nursing and family health nursing into a single community health nurse role (CHN) role. The new role was piloted in three Health Boards across Scotland. This publication reports on the findings of a study which explored the implementation of the new role in these areas. The report provides insight into some of the structural and other challenges which affected the uptake and implementation of the Community Health Nurse. The research concluded that while there was broad support for the core elements of the role such as self-care, public health approaches and prevention, the study participants thought that rather than focussing on changing nurse roles, more should be done to improve interagency working and foster better collaboration among the existing nursing disciplines. The study highlighted a number of issues of relevance to ongoing work of the Modernising Nursing in the Community Programme

Evaluation of Healthy Respect phase two: final report

The Healthy Respect National Health Demonstration Project represented the Scottish Government’s response to the poor sexual health of young people It consisted of two phases and was implemented across Lothian including Edinburgh City. Healthy Respect One began in 2001 and ended in 2004, andHealthy Respect Two began in 2005 and ended in March 2008. This report contains the findings from the evaluation of Healthy Respect Two. aimed to integrate education, sexual health services and information for young people aged 10 to 18 years (although sexual health services were aimed at 13 to 18 year olds) across Lothian and was supported by an overarching communications strategy that included branding and media campaigns

Evaluation of Healthy Respect phase two: final report

The Healthy Respect National Health Demonstration Project represented the Scottish Government’s response to the poor sexual health of young people It consisted of two phases and was implemented across Lothian including Edinburgh City. Healthy Respect One began in 2001 and ended in 2004, andHealthy Respect Two began in 2005 and ended in March 2008. This report contains the findings from the evaluation of Healthy Respect Two. aimed to integrate education, sexual health services and information for young people aged 10 to 18 years (although sexual health services were aimed at 13 to 18 year olds) across Lothian and was supported by an overarching communications strategy that included branding and media campaigns