Does Health Promotion Work?

1. Does Health Promotion Work? Puja Myles

2. Outline of lecture • Learning Outcomes • Designing a health promotion intervention • Types of evaluation questions and perspectives • Outcomes • Special evaluation methods • A generic evaluation framework • Practical exercise

3. Learning Outcomes At the end of this session you should be able to: • Design a health promotion intervention using previously covered theoretical frameworks and concepts • Frame an evaluation question for a given health promotion intervention • Plan an evaluation for a given health promotion intervention using appropriate methods and outcomes

4. Designing a health promotion intervention/programme-1 • Identify priorities for action: • National priorities/targets • Health Needs Assessment • Health Equity Audit • Targeted vs. population approach • Decide Intervention - Evidence on effectiveness and cost-effectiveness

5. Designing a health promotion intervention/programme-2 • Decide programme goals • Monitoring* -what will you monitor? -how often? • Evaluation*

6. The need for the evaluation Why do you want to conduct an evaluation: • How well are we doing? • Are we doing things right? • What difference are we making? Accountability • Has the intervention worked? • Has the money been well spent? • Should we continue to invest in this project?

7. Efficacy, effectiveness and efficiency* • Efficacy- does an intervention work in ideal conditions? • Effectiveness-does an intervention work in real life? • Efficiency-ratio of useful output to total input; incorporates the notion of minimising waste.

8. Evaluation perspectives-1 • Developmental/formative • Process • Summative -Outcome evaluation* -Impact evaluation* (Ovretveit, J.)

9. Evaluation Perspectives-2 • Many perspectives • The number of perspectives directly proportional to number of stakeholders • Depending on perspective adopted, evaluation question, design and outcomes will change

10. Health Outcomes

11. Influence of Health Perspectives 1 Biomedical Model of Health • Health = Absence of disease(pathology) • ‘Functionalist’ approach • Objective, numerical measurements based on ability to function • Preconceived assumptions about individual perceptions of health

12. Influence of Health Perspectives 2 Social Model of Health • ‘Disease’ and ‘Illness’ different concepts • WHO definition of Health • ‘Hermeneutic’ approach to measure aspects of health unique to individuals • Open-ended questions and qualitative

13. Qualitative versus Quantitative • Quantitative - quantifiable • reliable, • generalisable (? possibly) • Decontextualises processes • Qualitative -provides context -understanding of the ‘whys’ -generalisability is a major issue

14. Health Outcomes- examples • Health Behaviours • Adherence to treatment • Specific Diseases • Depression • Emotional balance or well-being • Global health status using SIP or SF-36 • Self-reported health status

15. Health Outcomes? • Self-confidence • Self-efficacy • Social involvement • Sense of achievement/direction • Stress relief • Participation in social networks

16. Special evaluation methods • Audits • Health Equity Audits • Economic Evaluations

17. Audit • Where are we in relation to the Gold standard? • Audit loop or cycle

18. Health Equity Audit • Health Equity profiling compares how the relationship between health need and service provision/use varies across the different dimensions of equity • Equity profiling is just one step in the health equity audit cycle: re-audit to close the loop!!

19. Economic evaluation

20. What is the question? • Is this activity worthwhile? • Is this an efficient way to achieve a particular outcome? • Are the healthbenefits of this activity justified? • What is the least cost way to achieve a given outcome?

21. Allocative efficiency vs. technical efficiency • Allocative efficiency • cost-benefit analysis • cost-utility analysis • cost-consequences analysis • Technical efficiency • cost-effectiveness • cost-minimisation

22. A good economic evaluation: • Were both costs and effects of the services/programmes considered? • Comparison of alternatives • Statement of perspective from which the evaluation is conducted

23. A dummies guide to… …bringing it all together

24. Applying the PT-DES approach

25. The Healthy learning Project • Multi-agency partnership: local authority, education, health, voluntary sector • Learning advisors in GP surgeries • Referrals by: health professionals, self • Information/advice on learning, careers, leisure, skills (including life skills), lifestyle

26. PT-DES:Step 1 ‘Involving stakeholders and developing programme theory’ • Identify Relevant Stakeholders • Develop common understanding of project context and objectives

27. Step 1 cont. Stakeholders in the Healthy Learning Project: • Learning Advisors • Clients/beneficiaries • General Practices • Referrers • Project Steering Group (education, regional economic partnership, local government, health)

28. PT-DES: Step 2 ‘Formulating and Prioritising evaluation questions’ • Demographic characteristics of clients • Source of referral • Reason for referral (client and referrer) • Responders vs. non-responders • Physical and/or mental health outcomes

29. PT-DES: Step 3 ‘Designing and conducting the evaluation’ Criteria for assessing suggested health outcome measures: • Relevance to project context • Suitability within time and resource constraints

30. Evaluation assignment: Suggested framework 1 • Problem and intervention (what, who, where) • Why is the evaluation needed (purpose) • Evaluation question • Define stakeholders and evaluation perspective • Define measurable outcomes

31. Evaluation assignment: Suggested framework 2 • Study design (include discussion of why this is appropriate, strengths, limitations) • Data collection • Analysis and dissemination • Alternative evaluation approaches that could have been used (brief discussion)