Evaluation framework: Promoting health through strengthening community action

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Evaluation framework Promoting health through
strengthening community action

• Lori Baugh Littlejohns
• Neale Smith
• David Thompson Health Region,
• Red Deer, Alberta

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Ottawa Charter for Health Promotion

• One strategy strengthen community action
• Importance of concrete and effective community
  action in setting priorities,
• making decisions,
• planning strategies,
• implementing them to achieve better health.
• WHO, 1986

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2 programs in DTHR to strengthen community
action

• Healthy Communities Initiative
• Health Promoting Schools Initiative

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Why the framework Big picture

• We are working with evolving new theory of how to
  best partner with communities that has not yet
  been fully proven in practice.
• There are essentially no established ways to
  measure the success of these new strategies and
  approaches.

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Why the frameworkPractice picture

• Community action requires new skills of health
  care not well understood lack of support for
  participatory methods.
• Health care workers perceptions of evaluation
  performance appraisal.
• Community members skepticism of evaluation lack
  of integration learning.

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Why the frameworkEvaluation picture

• Safe meaningful steps needed.
• Simple data collection methods tools required.

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Why the framework Different pictures

• Ongoing performance measurement
• regularly reported
• established expectations
• accountability

• Evaluation
• as needed
• unintended impacts
• contextual factors
• why questions

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Evaluation framework2 core concepts

• Community capacity

• Organizational capacity

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Community capacity

• the ability of people and communities to do the
  work needed in order to address the determinants
  of health for those people in that place
• Bopp, GermAnn, Bopp, Baugh Littlejohns, Smith
  (2000)

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What are we building?

• Shared vision
• Participation
• Leadership
• Communication
• Ongoing learning
• Resources, knowledge skill
• Sense of community

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Formation of Core Groups
Core Group
Adherence to principles?
Responsive?
Satisfaction with the process?
Perceived benefits of process?
Vision
Visioning
Adherence to principles?
Responsive?
Satisfaction with the process?
Perceived benefits of process?
Community Assessment
Community Profile
Adherence to principles?
Responsive?
Satisfaction with the process?
Perceived benefits of process?
Selection of Key Priority Areas
Key Priority Area(s)
Adherence to principles?
Responsive?
Satisfaction with the process?
Perceived benefits of process?
Action Planning
Action Plan(s)
Implementation of Actions and Action
Plan(s) Effective? Efficient? Participation and
partnerships?
Adherence to principles?
Responsive?
Satisfaction with the process?
Perceived benefits of process?
change in community capacity
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Change in community capacityOutcomes

• Short term
• Planning activities (benefits of process e.g.,
  shared vision)
• Outputs (utility of product e.g., vision)
• Implementation of action plan (s)

• Long term
• community-level and school-level indicators
  (e.g., participation)
• track and monitor measurable changes in community
  capacity

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Short term Tools for evaluation

• Activities
• Description, why, participation, collaboration,
  outcomes (e.g., core group, visioning).
• Building understanding of health, building
  capacity for leadership, etc.
• Process
• Choose a number between 1 (low) - 5 (high)
  explain.
• Understanding the process, champions identified,
  visioning completed, actions planned

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Organizational capacity

• the potential ability of a health organization
  to develop an empowering and democratic
  partnership with a community, through which the
  communitys capacity to identify and address
  health concerns is strengthened
• K. GermAnn (2000)

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Building organizational capacity Examples from
logic model
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Change in organizational capacity Outcomes

• Short term
• Org commitment to supporting community action
• Resources to make it possible ...
• Org structures that make it possible ...
• Behavioral processes or internal climate that
  models ...

• Long term
• Integration/system alignment goals objectives
  are understood, integrated, coordinated
• Improved health and well-being evidence from
  monitoring

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Short term Example

• Organizational commitment
• There is a shared understanding of what the
  community action team can achieve
• There are champions of community action at the
  Authority and Senior management level

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Short termTools for evaluation

• Activities
• e.g., description (best practice? people? who
  was involved? what difference?) of the school
  health workshop how it built understanding
  among Public Health staff.
• Process
• e.g., on a scale from 1 -5 how much progress was
  achieved this year with respect to PH staffs
  understanding of HCI/HPSI process?

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Where are we ...

• Next steps
• Establish indicators for long term outcomes
  performance measurement