1. No category

Health Promotion Interventions
for beginners… and for those who’ve been
there and got the T-Shirt
Kathy Cobain, Amanda Drakeley & Beck Taylor
4th July 2012
Agenda for today:
0930
0950
1020
1030
1100
1200
1245
1430
1500
Introduction & overview
PART 1: What is health promotion?
Break
PART 2: The role of theory and evidence in
health promotion
PART 3: Approaches to health promotion
Lunch
PART 4: Implementing a health promotion
intervention in the real world: a practical
exercise and post-mortem (coffee to be
taken during this time)
PART 5: Reflective practice
Close
Introduction and overview
Aim of today:
To deliver a session on health
promotion to allow novices to the
areas to learn the fundamentals
but for experienced practitioners
in this area to be able to discuss,
reflect and evaluate their current
practice.
Learning outcomes:
By the end of this masterclass the practitioner should be
able to:
1.
Understand key points in history
2.
Understand key terms
3.
Discuss of the role of, and how to find and use health
promotion theories/models
4.
Understand importance of evidence and policy
5.
Describe the different approaches to health promotion
6.
Consider design, planning, barriers, monitoring and
evaluation
7.
Understand realities of implementing health promotion
The pre-masterclass survey
• We decided to send out the pre-masterclass
survey to gain an understanding of who we
would have in attendance, particularly:
–
–
–
–
Knowledge about health promotion
Qualifications in health promotion
Experience in delivering health promotion
Current job role in relation to health promotion
• Sent to 39 proposed attendees.
• Response of n = 22 (56% response rate)
The results are as follows…
Knowledge:
Q1) How would you rate your knowledge of health
promotion?
13.6
0
27.3
None
Novice
Intermediate
Expert
59.1
Qualifications:
Count of participants who
ticked each type
Q2) What qualifications do you have on the topic of
health promotion?
9
8
7
6
5
4
3
2
1
0
None
Certificates Certificates Vocational
- one day
- days /
courses
weeks/
months
Degree
level
courses
Types of qualifications
Higher than
degree
Other
(please
specify)
Areas of work
Other
(please
specify)
Audit /
Research
Evaluation
Strategic
leadership
Plan /
Develop /
Implement
Managing
(staff &
perf'mance)
Practical
delivery
None
Count of participants who
ticked each area
Experience:
Q3) What experience do you have in working in health
promotion?
18
16
14
12
10
8
6
4
2
0
Current job role:
Q4) How much does your current job role relate to health promotion (in
your opinion)?
0
18.2
22.7
Not at all
A little
9.1
A moderate amount
A lot
All of it
50
A range of roles…
• Tobacco Control
Co-ordinator
• Senior Health Improvement
Specialist
• Health Development
Officer
• Environmental Health
Officer
• Public Health
Epidemiologist
• Health Intelligence Analyst
• Health Check Co-ordinator
• Health Improvement
Practitioner Specialist
• Health Trainer
• Health & Wellbeing
Strategy Officer
• Falls Management Lead
• Health Information & Social
Marketing Officer
• Specialist Stop Smoking
Advisor in Pregnancy
• Breastfeeding Support
Coordinator
• Public Health Adviser
• Health Improvement
Worker – Smoking
Cessation
• Lifestyle risk
implementation Manager
So that’s all of you….
But what about us?
Kathy
• Specialty Registrar in Public Health, Year 2
based at Worcester PCT.
• Previous experience:
– Clinical Nurse Specialist Drug and Alcohol
– PhD "Alcohol Treatment in the NHS: Challenging the
Paradigm”
– involved in a national alcohol needs assessment for
the DH
– Research Fellow Public Health and Primary Care
(NHS and University)
– BSc Psychology & MSc Health Psychology
Amanda
• Specialty Registrar in Public Health, Year 4
based at Staffordshire Public Health.
• Previous experience in planning, developing and
implementing health promotion initiatives:
–
–
–
–
–
–
Walking for Health Scheme
Exercise on referral programme
“Sport Relief” events
“Fruity Friday” campaigns
No smoking day events
Community health fairs, etc.
Beck
• Clinical Research Fellow in Public Health,
based at Birmingham University (having
completed the public health training
scheme).
• Current experience:
– Working on a PhD (lay health worker interventions).
– Research interests include health inequalities, lay
worker interventions, policy evaluation and the role of
theory in public health.
– The use of realistic evaluation and its application in
complex interventions (Health Trainers).
So, in summary…
This health promotion masterclass is about:
• Understanding the fundamentals
• Exploring further
• Sharing, reflecting on and evaluating your own practice
And why is this relevant to you?
In public health roles, you may need to:
• Develop your own idea
• Project manage local implementation
• Advise on how to develop/implement
• Assess the evidence for an ‘evidence based’ intervention
• Decide whether or not to fund an intervention
PART 1 - Agenda
Learning Outcome 1:
Understand the key points in the history and evolution of health
promotion (including the relationship between health education
and health improvement).
Learning Outcome 2:
Understand the key terms around health promotion
What is health promotion?
•
•
•
•
•
A brief history & the Ottawa Charter
Understanding health
Factors that influence health
Inequalities in health
Group work task
The “old” public health
• In the 19th century:
• Most histories of public health begin with this
“sanitation phase”
– a period characterised by environmental issues such
as housing, working conditions, supply of clean water
and safe disposal of waste.
Reduction in infectious diseases
The rise of health education
• In the early 20th century: a second phase known as the
“Personal hygiene era”.
– Prevention is better than cure!
– Local authorities extended services beyond preventing disease to
improving health through health education.
• Examples:
– School children were taught hygiene principles (i.e. teeth brushing)
– Parents (mothers) were taught hygiene, nutrition and childcare in
the home (through home visiting).
• Central Council for Health Education was first established in
1927 – financed by local authority public health departments.
• Health Education Council created in England 1968 as an Non
Government Organisation.
– Create a climate of opinion generally favourable to health educ.
– Develop blanket programmes of education and (target) selected
priority subjects.
The health promotion movement
By the mid-1980s:
it became wider acknowledged that effective health
education involved making healthier choices easier:
– Proposing a wider agenda which involved modifying
circumstances, environment and policy to become more
“health promoting”.
– So people had opportunities to choose a healthier lifestyle.
– Recognised that people’s capacity to take action was
limited by environmental / social circumstances.
The first International Conference on Health
Promotion was held in Ottawa on November 21,
1986. It was at this conference that The Ottawa
Charter for Health Promotion was adopted.
The Ottawa Charter (WHO 1986)
The Ottawa Charter for Health Promotion provided a
further impetus to an emerging modern health promotion
movement.
Definition: “Health promotion is the process of enabling
people to increase control over, and to improve their health”.
Ottawa Charter for Health Promotion. WHO, Geneva,1986
Over the last 25 years, the Ottawa Charter has been highly
influential, constant point of reference for those involved in
promoting health:
http://www.who.int/healthpromotion/en/
Health Promotion Emblem
It identified:
3 basic strategies:
"enabling, mediating, and
advocacy”
5 key themes:
1.
2.
3.
4.
5.
Build healthy public
policy
Create supportive
environments
Strengthen community
action
Develop personal skills
Reorientation of health
services
Logo visualises the idea that health promotion is a comprehensive multi-strategy approach
Understanding health?
In order to fully understand health we should
consider the following two questions:
1. How should health be defined?
2. Why is defining it so important when
promoting public health?
Definitions of health
• Health as “absence of disease”
– Medical model of health
– Can be traced back as far as the ancient Greeks
• Health as “well being”
Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity
(WHO 1948)
• Health as “a resource”
Health is a resource for everyday life, not the object of living.
It is a positive concept emphasizing social and personal
resources as well as physical capabilities
(Ottawa Charter for Health Promotion. WHO, Geneva, 1986)
A new definition? (June 2011)
The WHO definition of
health
as
“complete
wellbeing” is no longer fit
for purpose given the rise
of chronic disease. Huber
and colleagues propose
changing the emphasis
towards the ability to
adapt and self manage in
the
face
of
social,
physical, and emotional
challenges…
BMJ 2011;343:d4163 doi:
10.1136/bmj.d4163
Why is defining health so
important?
The answer?:
The way in which people think about health and well being influences
their health behaviours. Hughner & Kleine (2004).
Thus in order to effectively promote health, we need to interrogate its
meaning (UKPHR indicator 5e) to:
Individuals
An individual’s perspective and expectation of health is highly fluid and
interchangeable (depending on both their characteristics and experiences)
–
–
–
–
Lay concepts of health
Young Vs old
Women Vs men
Lower socioeconomic groups
Societal / Cultural
– Health & illness influenced by magic / witch craft, fatness seen as healthy,
etc.
Factors that influence health
The factors which influence health are:
– multiple and interactive
– both within and outside an individual’s control
– modifiable or non-modifiable
Health promotion is fundamentally concerned with action
and advocacy to address the full range of potentially
modifiable determinants of health:
– not only those which are related to the actions of
individuals (health behaviours and lifestyles)
– but also factors such education, employment and
working conditions and the physical environments.
Non-modifiable determinants of health:
– biology and genetics.
“Seeing the bigger picture”
• Wider
determinants
of health: an
influential
framework by
Dahlgren
and
Whitehead
(1991)
(UKPHR indicator 5b)
Dahlgren and Whitehead
(1991)
Illustration of the wider determinants of health,
identifying layers which influence health from
individual to societal to global.
Used to flag inequalities in health, identifying
socio-economic, cultural and environmental
factors which affect health.
Identifies the need for structural interventions to
impact on the causes.
Social Determinants of Health
• The social determinants of health “are the conditions in
which people are born, grow, live, work and age,
including the health system”.
– These circumstances are shaped by the distribution of money,
power and resources at global, national and local levels, which
are themselves influenced by policy choices.
• Healthy public policy = “characterized by an explicit
concern for health and equity in all areas of policy, and
by an accountability for health impact. The main aim…to
create a supportive environment to enable people to lead
healthy lives…makes healthy choices possible or easier.
It makes social and physical environments health
enhancing”. (WHO Health Promotion Glossary)
• The social determinants of health are mostly responsible
for health inequities – the unfair and avoidable
differences in health status seen within and between
countries.
Inequalities in health
• What are health inequalities?
• Examples of ways of measuring inequalities:
– Individual level
– Area level
• Explanations for inequalities?
• UKPHR indicator 5d
What are health inequalities?
• Inequality: unequal
“differences in health status, or in the distribution of
health determinants, between different population
groups”.
• Deprivation: a relative and broad concept, referring to
not having something that others have.
“a state of …observable and demonstrable disadvantage
relative to the local community or the wider society or
nation to which an individual, family or group belong.”
(Townsend, 1987).
• Inequality Vs Inequity
Measuring inequalities
• Individual level: socio-economic
position
Education, occupation, social class, employment
status, income, access to amenities, housing,
etc.
• Ecological/Area level: deprivation
Townsend, Carstairs, Jarman, Indices of
Deprivation 2010, etc.
If you’re really keen…
• The Indices of Deprivation 2010
(ID2010) is the 3rd release in a
series of statistics produced to
measure multiple forms of
deprivation at the small spatial
scale.
• Updates the Indices of
Deprivation 2007 and 2004
– retaining broadly the same
methodology, domains and
indicators
145 pages later….
http://www.communities.gov.uk/pu
blications/corporate/statistics/indic
es2010technicalreport
Explanations for inequalities?
Artefact
• Artefact, biases and changes in the way the statistics are
produced.
Social factors
• Social selection
• Stressors & coping capacity
Behaviour
• Lifestyle factors
Material circumstances
• Poverty
• Poor environments
TASK 1: Understand the key terms
around health promotion
Mapping of the World Health
Organisation (WHO)
Health Promotion Glossary
of key terms.
This Health Promotion Glossary
was prepared on behalf of WHO by
Don Nutbeam.
Includes both basic and an extended list of
54 terms which are commonly used in
health promotion. (UKPHR indicator 5c)
FIND THIS GLOSSARY AT: http://www.who.int/healthpromotion/about/HPG/en/
Time for a short
break…
PART 2 - Agenda
Learning Outcome 3:
Discuss the role of theories and models of health and health
promotion, and understand how to find and use them.
Learning Outcome 4:
Understand the importance of evidence and policy and its impact
of health promotion.
The role of theory and evidence in health promotion
•
•
•
•
What is theory / different types
Theoretical perspectives / using theories in context
The role of evidence
Group work task
What is theory?
• The ‘journey’ from A to Z, or ‘present state to health
improvement’
– Not just one step or academic theory, e.g. “We used the
transtheoretical model”.
• Purpose: so that everybody understands it
– You and your team, commissioner, client, wider PH etc.
– Success in implementation can be measured
– It can be replicated and adapted by you and others
• Ask yourself:
– What are you trying to do?
– How is it supposed to work?
– What needs to be in place for it to work?
Types of theory
•
•
•
•
•
Management and business
Psychology and behaviour
Communications
Community / social
And many, many others…
Several theories (or none?) can be used to build
your own intervention’s theoretical pathway.
A very useful introduction to
health promotion theory
Today isn’t about us
teaching you all the
different health
promotion theories or
models…
For further reading:
this book is
recommended.
Theoretical perspectives?
• Is it possible to promote public health
successfully without an understanding of some
of the theoretical, conceptual or research issues
than underpin public health practice?
– The answer is probably yes.
• However, to promote health effectively, practice
should be underpinned by relevant knowledge
(theoretical, conceptual, methodological) AND
appropriate skills AND…
Depending on the context!
• When promoting health, practitioners may draw
from the many theories and models from
different disciplines, depending on their focus.
• Theories and models can be categorised in a
variety of ways, but the key to ensure those
chosen are appropriate to the task.
• Therefore, match theory to the task and context.
Why re-invent the wheel?
• Finding and using promising and evidence based
practices, as well as models and tools developed by
others, is an important way to learn from one another
as we strive to deliver the most effective initiatives
possible
• Increasingly, we are able to base health promotion
decisions and interventions on evidence. This involves
using information derived from formal research, and
program evaluation.
• Thus our evidence base for health promotion could draw
from theory / models, research and practice.
The role of evidence
• We live in an ‘evidence-based’ world.
• Several steps:
–
–
–
–
Find it: know how to use resources (or who to ask)
Appraise quality: is it any good?
Appraise results: is it effective?
Appraise relevance: is it important to me? Can it be
applied locally?
• Problems with HP evidence:
– Often ‘grey’ – ask the experts
– Often pragmatic / ‘low quality’
– Often complex and specific
Lessons learned from practice
• It isn’t ‘evidence based’ if your evidence only
explains some of it.
• Understand context of intervention: will this work
with my population/organisation?
• Some things with no evidence may still be worth
doing – this is hard to explain to commissioners!
TASK 2: Matching evidence to the
task and context
•
Working with your table as a group.
•
You will be given a health promotion topic /
setting:
–
–
–
–
–
–
Alcohol abuse
Teenage Pregnancy
Breast screening (increasing uptake)
Workplace
Breastfeeding peer support service
Cardiac Rehabilitation
Task 2 (continued)
In 15 minutes, discuss in your group how you
would:
1.
Define the intervention
2.
Find evidence to design and implement it
• Would you use research, best practice, real-world
evaluations, theories/models, etc…
3.
Use the evidence that you find
• Identify any strengths and weaknesses.
• Would the evidence actually be useful in practice?
4.
Prepare 1-2 minutes feedback for the whole group
• Describe how you have gone about the task for your
topic / setting.
PART 3 - Agenda
Learning Outcome 5:
Describe the different approaches to health promotion.
Approaches to health promotion
•
Discussion: experiences in health promotion
•
National policy and its impact on heath promotion
•
Different health promotion approaches
•
Group work task
What kinds of experiences do you have of
doing health promotion (or health
education or health improvement) with
citizens in local communities?
Healthy lives, Healthy people (DH, 2010.)





Radical localism: local authorities leading role.
‘Health and well-being boards’: strategic planning for public health.
Emphasis on prevention and health improvement.
Health improvement not defined clearly.
Health promotion by ‘any willing provider’?
Key messages:
 Help citizens make better choices.
 Power and responsibility in the hands of the people.
 Strengthen individual’s self esteem, confidence and sense of
responsibility.
 Ladder of interventions.
 Least intrusive approach.
What are Health behaviours?
Health behaviour refers to activity that a well
person would engage in order to prevent
illness.
Illness behaviour concerns the behaviour
someone would engage in order to find out
what is wrong with him or her and to procure
a remedy.
Sick-role behaviour concerns the behaviour a
patient engages in to overcome their illness.
The 'ideology of health promotion'
Health promotion is concerned with strategies for
promoting health.
Assumptions
(a) good health is a universally shared objective.
(b) there is agreement on what being healthy
means.
(c) there is a scientific consensus about which
behaviours facilitate good health.
Health Promotion Approaches
Naidoo and Wills (2009) identified five different
‘approaches’. These approaches are not theories
or models, but descriptions of the practice
of health promotion:
 Medical
 Education
 Behaviour change
 Empowerment
 Social change
Medical Approach - What is it?
Aim
Reducing morbidity or mortality, by targeting risk groups or risk
behaviours with medical interventions.
Objectives
Detection and prevention to avoid of mitigate disease
Process
Concepts of primary, secondary and tertiary prevention. Through
immunisation, screening, surgery, medication
Assumptions
Application of Medical knowledge (evidenced based practice)
Expertise: technical, professional authority of professionals important.
Compliance/concordance by patients required
Medical Approach - An example
Criticisms - Medical Approach
Conceptualized around absence of disease
Does not seek to promote positive health
Ignores the social and environmental
dimensions of health
Encourages dependence on medical knowledge
Removes health decisions from lay people
Education Approach - What is it?
Aim
To provide knowledge and information and develop necessary skills so
that people can make an informed choice about their health behaviour.
Objectives
To enable personal choice
Process
Giving knowledge, information and skills development to make an
informed choice. It does not set out to persuade or motivate change in
a particular direction. Psychological theories; Cognitive, Affective and
Behavioural. Provision of leaflets, booklets
Assumptions
The relationship between knowledge and behaviour; that by increasing
knowledge there will be a change in attitudes which may lead to
changed behaviour.
Education Approach - An example
Social Marketing (NSMC, 2006)
 Argued to be different to commercial marketing: values
of individual autonomy, equity and social justice
integrated.
 Complements other public health and health promotion
activities and measures.
 Theory: derived from advertising knowledge, psychology,
sociology, social psychology, communication theory,
ecological theory.
 Methods: market research, communication, media
campaigns, advertising, promoting health literacy.
 Offers potential for assisting with learning and behaviour
change.
Criticisms - Education Approach
Approach used widely, informally and
opportunistically, in many settings and sectors.
Increasing knowledge and changing beliefs or
attitudes does not necessarily lead to changes in
behaviour.
Behaviour Change ApproachWhat is it?
Aim
To increase individuals' knowledge about the causes of health and illness.
Objective
To bring about changes in individual behaviour through changes in individuals'
cognitions.
Process
Provision of information about health risks and hazards.
Conceptually under-pinned by psychological theory. Most commonly top-down
expert-led. (targeted/population)
Assumption:
Humans are rational decision-makers whose cognitions inform their actions.
Health a property of individuals. People can make real changes by choosing to.
Blameworthy.
Behaviour Change - An example
Stages of Change Model
(Transtheoretical model, Prochaska & DiClemente1992)
–
–
–
–
–
–
Precontemplation
Contemplation
Planning
Action
Maintenance
Termination
Criticisms - Behaviour Change
Approach
 Is unable to target the major socio-economic causes of ill health.
 Operates top-down.
 Assumes that there is a direct link between knowledge, attitudes and
behaviour.
 Assumes homogeneity among the receivers of health promotion
messages.
 Blameworthy.
 Priority agenda of policy makers, commissioners, managers (but not
necessarily clients or citizens)?
 Change may take place over months and years?
 Does not adequately address the problem of ‘endless’ stress in
communities where material deprivation is a key social determinant
of health?
Do multiple stresses and strains
undermine the capacity of those, in
poverty, to change?
Empowerment Approach –
What is it?
Aim
To increase control over one's physical, social and internal environments.
Objective
To empower individuals to make healthy choices. “Health promotion is the
process of enabling people to increase control over, and to improve their
health” WHO (1984).
Process
Participatory learning techniques.
Assumption
Power is a universal resource which can be mobilised by every individual.
Empowerment Approach Techniques
•
•
•
•
•
•
•
Participatory learning
Group work
Problem solving
Client-centred counselling
Assertiveness training
Social skills training
Educational drama
Ladder of Participation
(Arnstein, 1969)
Participation Gradient
Criticisms - Empowerment
Approach
• It is assumed that rational choices are healthy choices;
• Strong reliance upon simulation;
• Inadequate concept of power.
• What if citizens choose issues that are at odds with
health policy priorities?
• Long term, time consuming? Cost effective?
• Outcomes difficult to measure (as aims may change)?
• How serious are policy makers, commissioners and
managers about participation?
• An under resourced alternative to public investment?
Aim
Social Change Approach What is it?
To modify social, economic and physical structures which generate ill
health.
Objective
To improve health by addressing socio-economic and environmental
causes of ill health.
Process
Individuals organize and act collectively in order to change their
physical and social environments. Lobbying, change within
organisations.
Assumption
Communities of individuals share interests which allows them to act
collectively
Social Change Approach - Some
examples
Changing Organisations
(HCAI; Nutritional standards for school meals)
Changing Communities
(Health Action Zones; Healthy Cities; Children’s Centres)
Changing Policies and Legislation
(Seatbelts, Cigarette Advertising, Smokefree legislation)
Criticisms - Social Change
Approach
 Most health care professionals have a limited role in developing
policy (may be policy literate or implement policy)?
 Wider political activity more likely to take place outside of
professional and semi-professional roles (BMA, RCN, UKPHA,
Politics of Health Group, trade unions, political parties, social
movements)?
 Wider political structural change more possible in societies with
strong egalitarian culture e.g. Sweden, Germany, New Zealand
(Blank and Burau, 2010)?
 Vulnerable to lack of funding and to official oppositions
 Danger of creeping professionalisation
 Problematic concept of 'community’
Summary
5 approaches identified by Naidoo and Wills (2009):
Medical
Educational
Behaviour change
Empowerment
Social change
TASK 3: Applying health promotion
approaches
In 15 minutes, read the case study and answer
these questions in your groups:
1.
Which health promotion approach(es) are
appropriate for this case and why?
2.
Which approach is the highest priority? And
why?
Other Approaches
Settings (hospital, school workplace)
Lifespan
Targeted
Population
PART 4 - Agenda
Learning Outcome 6:
Give consideration to key areas of health promotion in practice, such as
design, planning, barriers to implementation, monitoring and evaluation.
Learning Outcome 7:
Have an understanding of the realities of developing, implementing and
evaluating a complex health promotion intervention (e.g. Health Trainers).
Real world implementation: a practical exercise & post
mortem
•
What is a complex intervention?
•
Designing and planning Health Trainers
•
Monitoring and evaluating Health Trainers
•
Barriers to implementing health promotion initiatives
Complex interventions?
• Mark Petticrew. When are complex
interventions ‘complex’? When are simple
interventions ‘simple’? Eur J Public Health
(2011) 21(4): 397-398
The issue of complexity, and how one evaluates
complex interventions, remains a key one for
health service and public health researchers….
Have a quick read…
What we can take away from the
article?
• Complex interventions:
– May consist of several components.
– Some, or all, of the components may contribute to its
effect (numerous outcomes)
– The components may, or may not, interact.
– The components may act at different levels (e.g. at the
level of the participant and at the organisational level).
– Flexibility in delivery (staff adapting to participants)
– Could be “unpacked” and analysed as simple
components
– BUT… is the whole greater than the sum of the parts?
A real life example now…
Real world implementation:
a practical exercise & post
mortem on NHS Health Trainers
NOTE: Please take your coffee
during this afternoon’s task
The idea: what is a Health Trainer?
• A (relatively) new type of NHS worker
• Drawn from, or knowledgeable about,
local communities
• Trained to provide practical support to improve health
• Work 1:1 with (usually) disadvantaged clients
• Assess lifestyle, set goals and support behaviour
change
• Focus on diet, exercise, smoking and alcohol
TASK 4a:
Where to start?
• In groups, imagine that you are a Public Health
Practitioner and you have been tasked with
implementing ‘Health Trainers’ in England based
on the ‘idea’ outlined in the previous slide.
• Spend 15 minutes sketching a strategy to
develop the Health Trainers idea – don’t worry
about lots of detail. Clue: remember this is just a
‘good idea’ at this stage - don’t roll it out across
the whole PCT before some further exploration.
Feedback: strategy task
Strategy: key points
• Define intervention (theory, evidence, expert opinion, etc.)
• Test on a small scale and evaluate
• Roll out incrementally
• Programme of evaluation, expansion and continuous
improvement (basically the commissioning cycle)
• Cost is increasingly important
• Involve all stakeholders at each stage, particularly
clients
TASK 4b:
Monitoring and Evaluation
• It is essential to include evaluation in any
implementation plan.
• In your groups, spend 10 minutes coming
up with some measures that could be
used to evaluate Health Trainers.
Feedback: evaluation task
Evaluation: key points
Aim for a balance of:
• Structure – Service in place, staff in post, funding
secured
• Process – Number of clients recruited to service,
whether clients were in target groups
• Outcome
– Short term – Clients achieving/maintaining goals,
satisfaction
– Long term – Reduction in risk factor prevalence/
mortality/morbidity, qualitative change in life
There is no right answer!
The Department of Health used the ‘DCRS’
database for Health Trainers.
A common conflict…
Similarities and differences between practitioner and
scientific evaluations of health promotion programmes
91
NHS Standard Evaluation Framework for Weight Management Interventions 2009
A note on controlled trials…
• The Medical Research Council advocates
controlled trials as part of phased
development
• What
are
the
advantages
disadvantages of this approach?
and
• Has anybody here ever been involved in a
trial?
Trial feasibility
• Is it possible to standardise communities?
• Is it possible to blind communities?
• If an intervention fails to ‘work’, are we
sure it’s because it is ineffective?
If in doubt, return to the
question you want to answer
(but remember that trials are not always
the answer)
TASK 4c:
Barriers to implementation
In your groups spend 15 minutes identifying
the potential barriers to implementing Health
Trainers.
Feedback: barriers task
Common barriers
•
•
•
•
•
•
•
•
Resources
Communication (in all directions)
People (power, politics, negativity)
Policy (and shifting goalposts)
Ethics
Ideology, e.g. libertarianism
Demand (or lack of)
Lack of clear strategy.
Comments on HT task?
PART 5
Time for some reflection
and learning…
Reflection
“Follow effective action with quiet
reflection-from the quiet reflection will
come even more effective action”
Peter F Drucker (1909)
Educator and Writer
What is it?
Reflection provides a structured opportunity for individuals
and groups to consider the ramifications of the service they
provided.
Why?
• Better role understanding.
• Makes a connection between the service you have provided and the
broader social issues that are impacting that population or community.
• A time for personal growth when individuals can look within, by
processing the knowledge and skills one acquires through service.
• Adds meaning and depth to any service project.
• Enables better recognition of the positive personal and societal
aspects of the activity.
• Provides evidence of development for your portfolio.
Models of Reflection
• Gibbs (1988)
• Johns (1995)
• Rolfe et al. (2001).
Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and
Learning Methods. Oxford: Further Educational Unit, Oxford
Polytechnic.
Johns C (1995) Framing learning through reflection within Carp
er’s fundamental ways of knowing in nursing. Journal of
Advanced Nursing. 22, 2,226-234
Description of the experience
Describe the experience and what were the significant factors?
Reflection
What was I trying to achieve and what are the consequences?
Influencing factors
What things like internal/external/knowledge affected my decision making?
Could I have dealt with it better?
What other choices did I have and what were those consequences?
Learning
What will change because of this experience and how did I feel about the experience How
has this experience changed my ways of knowing
• Empirics – scientific
• Ethics – moral knowledge
• Personal – self-awareness
• Aesthetics – the art of what we do, our own experiences
Rolfe, G., Freshwater, D., Jasper, M. (2001) Critical Reflection in
Nursing and the Helping Professions: a Users Guide.
Basingstoke: Palgrave Macmillan; 2001
What:–
Describe the situation; achievements, consequences,
responses, feelings, and problems.
So what:–
Discuss what has been learnt; learning about self,
relationships, models, attitudes, cultures, actions, thoughts,
understanding, and improvements.
Now what:–
So…. over to you!
And finally…
Please provide some
feedback for us…
Thank you and
safe journey home!
Best wishes
Kathy, Amanda & Beck