Researching Processes and System-level Change

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Researching Processes and System-level Change

• Penny Hawe
• Markin Institute, University of Calgary
• phawe_at_ucalgary.ca

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Take home message

• When it comes to school-based health promotion,
  whats inside the black box is still
  unclear/contested
• Useless programs tell us important things
• We need to shift from program thinking to system
  thinking

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The Gatehouse Project changes in health risk
behaviour in year 8 students after 2 years
All analyses adjusted for previous level of
substance use in the school
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Theoretical Framework of the Gatehouse Project
Security
Communication
Positive regard
Opportunities
Skills
Opportunities
SOCIAL AND LEARNING ENVIRONMENTS
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• Social change processes matter.
• Social processes are easy to miss and elusive to
  track.
• But if we want to be more intentional and
  effective in creating supportive school
  environments, wed better get better at
• measuring and recognising them.

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TODAY

• Looking inside the black box to understand
  change processes
• Insights from useless programs
• The promise of system thinking

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Prevention Studies, Implementation
FindingsBattish et al (1996) 66 of schools
did not implement the program
properlyRohrbach et al (1993) 79 teachers
omitted program componentsTaggart et al
(1990) 65 teachers did not implement
properlyFlannery et al(1993) 67 teachers
miss key components
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Dulak JA, J Prev Intervention in the Community
1998175-18
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Implementing preventive interventions

• Dosage Providing sufficient exposure to the
  program
• Adherence Following methods as outlined
• Quality of process Active methods to engage
  students
• Adaptation Modification to developmental or
  cultural needs
• teacher attitude and experience

Dusenbury et al Health Ed Res 200420(3)308-313
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Prevention Studies, Implementation
FindingsBattish et al (1996) 66 of schools
did not implement the program
properlyRohrbach et al (1993) 79 teachers
omitted program componentsTaggart et al
(1990) 65 teachers did not implement
properlyFlannery et al(1993) 67 teachers
miss key components
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Dulak JA, J Prev Intervention in the Community
1998175-18
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Thinking of my teachers this term, I really
like..

• All of them 14
• Most of them 42
• Half of them 16
• One or two 25
• None of them 3

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What is formally taught or implemented
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Three perspectives on innovation

• Technological perspective
• Political perspective
• Cultural perspective

House ER. Three perspectives on innovation. In
Lehming, R., Kane, M. Eds Improving Schools.
Using What We Know. Sage 1981
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School Staff and Teacher Network Survey
Assessed - knowing by name - regular
conversations - knowing more personally -
advice seeking - socialising Twice. At the
start, and one year later.

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From the list below, tick of the name of the
people you talk with regularly (more than just
saying hi)
Ahmed Abboud Sue Smith Kyle Hilllary Gideon
Gluckstern Nick Quinn Tim Blythe Salim
Noosar Yvette Lemieux Josee Giscard Mitzi
Lamarack

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Ahmed Sue Kyle Gideon Nick Salim Yvette
Ahmed 1 0 0 1 1 0 0
Sue 0 1 0 0 1 0 1
Kyle 0 0 1 0 1 0 0
Gideon 1 0 0 1 0 0 0
Nick 0 1 0 0 1 0 0
Salim 0 0 0 0 0 1 0
Yvette 1 0 0 1 1 1 1
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Advice seeking a year ago
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Advice seeking now
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Socialising with each other a year ago
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Socialising with each other now
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Density of relationships, before and after ()

• Before After
• Knowing by name 66 95
• Knowing more personally 29 39
• Regular conversations 26 41
• Seeking advice 15 21
• Socialising with 6 8

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Two step reach for key actors
TIME 1 TIME 1 TIME 2 TIME 2
2-Step reach 2-Step reach
Knows personally Principal Vice principal 98 98 100 100
Reg conversations Principal Vice principal 75 73 100 98
Advice seeking Principal Vice principal 85 83 100 100
Socialise with Principal Vice principal 27 47 33 43
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A good result

• But it always depends on what type of networks
  are desirable
• - dense versus sparse
• - reciprocity
• - centrality of particular people
• ..it depends on your theory and objectives

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TODAY

• Looking inside the black box to understand
  change processes
• Insights from useless programs
• The promise of system thinking

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DARE Drug Abuse Resistance Education

• 33 million children 1983-1997, no evidence of
  effectiveness
• Costly. Average of 217-334 per child per year
• Renovated at cost of 13.7m in 2001, still not
  known if effective

Example 1
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• One of the most important benefits and by
  products is the relationship with the school
  department. It really couldnt be better. If
  ever I need anything all I have to do pick up the
  phone.
• Police Chief
• Evaluation and Program Planning
• 200226575-603

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Example 2
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• Physician innovator whose actions people want to
  reward, praise
• Manager wants to inform nurses of how some new
  thing should get done, so a leaflet with dual
  purpose gets designed
• Committee formed to develop a leaflet develops a
  solution that reflects everyones interests
• Public relations department updates, and makes
  more attractive, a leaflet designed by rival
  agency

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TODAY

• Looking inside the black box to understand
  change processes
• Insights from useless programs
• The promise of system thinking

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• You know you have changed a person when.
• You know you have changed a system when..

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System thinking.

• Inter-connections, interactions
• Local contextual meaning
• Feedback loops
• Amplification mechanisms
• Status of the parts of the system engaged in the
  intervention

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Essence of ecological system thinking

• Properties of social contexts keep replicating
  particular health outcomes...regardless of who
  is cycled through these contexts
• ..social roles, work roles,
  classrooms, schools.

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• Research implications

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