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Scaling up to a population health intervention: A readiness assessment framework

Scaling up to a population health intervention: A readiness assessment framework. Duyen Thi Kim Nguyen, MSc (Psychology) Doctoral student (Population & Public Health) Department of Community Health Sciences d.t.nguyen@ucalgary.ca PHIRNET Student Webinar. Purpose of this webinar.

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Scaling up to a population health intervention: A readiness assessment framework

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  1. Scaling up to a population health intervention: A readiness assessment framework Duyen Thi Kim Nguyen, MSc (Psychology) Doctoral student (Population & Public Health) Department of Community Health Sciences d.t.nguyen@ucalgary.ca PHIRNET Student Webinar

  2. Purpose of this webinar • To share my study purpose, research questions, background, and methods with the PHIRNET community • To obtain constructive feedback from trainees and experts in the field of population health, intervention research, evaluation, and scale up • To provoke discussions regarding knowledge gaps in scaling up and how to advance PHIR methods

  3. Purpose of my dissertation To develop a readiness assessment framework to assist stakeholders to determine if a health intervention is ready to scale up to a population-level intervention. Key terms: ready intervention scale up stakeholder population-level health

  4. How are health interventions initially scaled up successfully to population-level interventions? • How are health interventions sustained successfully as scaled up population-level interventions? • What are the key elements of successfully scaled up population-level interventions ? Phase 1: Scoping Review Research Questions

  5. Phase 2: Case study evaluation (CSE) Case = Stardale Phase 3: Test and refine the framework • What can we learn by piloting the readiness assessment framework on an existing community-level intervention? Research Questions cont’d

  6. Background • “Canada is a country of perpetual pilot projects” (Bégin et al., 2009, p. 1185) • Not necessary for all interventions to be scaled up (e.g., programs treating individuals) • Interventions using upstream approaches should be considered • PHI have potential for great health impact • Root causes • Reducing inequities and incidence

  7. Types and paths of scaling up (Uvin, 1995)

  8. Scaling up • Mangham & Hanson (2010) literature search in June 2008 • PubMed: ‘scaling up’ & ‘scaling-up’ • 1989-2001 = 2 citations re. scaling up & health interventions • 2001-2008 = 51 citations • July 2008-Feb 2012 = 132 citations • Scaling up Canada and globally • Conference to Advance the State of the Science and Practice on Scale-up and Spread of Effective Health Programs (2010)

  9. Phase 1: Scoping Review -Develop a Readiness Assessment Framework -Expert feedback and assess validity Phase 2: CSE -Provide evaluation report -Greater understanding of Stardale’s processes, outcomes, and more Phase 3: Test and refine the framework -Assess its utility & practicality (Stardale) -Feedback & assess validity (Experts) Readiness assessment framework to assist stakeholders to determine if a health intervention is ready to scale up to a population-level intervention

  10. Scoping Review: 101 Systematic review Scoping review Broad question Assessing scope & breadth Less constrained & iterative I/E Criteria defined post hoc Typically no study filters Quality assessment (optional) Examine extent, range, & mapping; Value of a sys review; Summarize & disseminate; Gaps • Focused question • Hypothesis-testing • Systematic & explicit method • I/E Criteria defined a priori • Study filters • Formal quality assessment • Synthesize the data to provide evidence in support/rejection of the research hypothesis

  11. Phase 1: Conceptual Framework Scoping: Arksey & O’Malley (2005); Levac et al, (2010) Readiness Assessment Framework: • Population health approach • Reducing health inequities and improving health among population groups (aggregate) • Focus on broad range of underlying conditions (PHAC, 2001) • Complex Adaptive Systems • “a collection of individual agents”; “not always predictable”; interconnected (Plesk & Greenhalgh, 2001, p. 625) • Individ properties ≠ Collect. properties (Matheson et al., 2009)

  12. 1) Database – PubMed, Medline, EMBASE, Global Health, Canadian Health Research Collection, CINAHL, PsycINFO, Social Services Abstract, Social Work Abstract, Cochrane Database of Systematic Reviews, ERIC, EconLit, & WHO Library and Information Networks for Knowledge Database (WHOLIS) 2) Grey literature - Scopus, select conferences regarding scale up (e.g., Conference to advance the state of the science and practice on scale-up and spread of effective health programs) and scale up studies and evaluations of organizations, companies, and government initiatives (e.g., ExpandNet) 3) Authors will be contacted for clarification, data, or further studies 4) Experts and research teams identified during the review process will be contacted for information regarding their knowledge of ongoing or unpublished studies or other consultation 5) Bibliography list of identified relevant publications; Select journals

  13. Quality Assessment Tools Downs & Black (1998) Checklist • Randomized & non-randomized studies • Scores fro overall study quality, quality of reporting, power, internal validly (bias & confounding), and external validity Critical Appraisal Skills Programme (CASP) appraisal checklist (Public Health Resource Unit, England, 2006) • 10 questions regarding rigour, credibility, and relevance Quality in Qualitative Evaluation (Spencer et al, 2003) • Focus on qualitative evaluation research Search on the Cochrane Qualitative Research Methods Group

  14. Categorization for organization & analysis Characteristics of Stardale Health outcome(s) Research Questions: Population characteristics Complexity NVivo 9 Theory behind the intervention Underlying condition(s) Context

  15. Sustainability processes Initial processes Key elements Key elements

  16. Expert feedback • Experts (academic, practice) • Population health • Intervention research • Scaling up • Surveys and/or semi-structured interviews • Face validity • Content validity (main domains present) • Feedback re. strengths, weaknesses, gaps

  17. Phase 2: Case Study Evaluation

  18. Stardale: Honouring the girls stories • Non-profit organization and registered charity • Honouring the Girls Stories (est. 2005) in Calgary, AB • Provides life skills, literacy education, and advocacy to urban Aboriginal female youths (10-17 years) • Organized activities afterschool (e.g., arts, tutoring, sporting events, dance, acting, modeling) • 2/wk from Sept-June; 6:00p-8:00p; with supports all year-round

  19. Participatory Approach • Doing research “with”,not “on” the participant (Minkler & Wallerstein, 2003) • Participatory = research design & implementation (Merriam, 2009), developing sense of ownership, create meaning, and increase likelihood of using the results (Patton, 2002) • Principles: Flexible design, building theory based on participants perspectives, simplicity, agreed topics, analysis reflects the detail and diversity, & share results with participants for informed conclusion (Rothe, 2000)

  20. Aboriginal Research/Evaluations • Tri-council guidelines re. Research involving the First Nations, Inuit and Métis peoples of Canada (Gov of Canada, 2011) • Aboriginal advisory committee • Key components (Johnston, 2008): • Unique way of knowing • Explaining in relevance to Aboriginal culture • In-person, verbal communication • Acknowledge Aboriginal core values • Time

  21. Case Study Approach • Case study method ideal when: addressing “why” and “how” questions; lack of control over events; contemporary phenomenon (Keen & Packwood, 1995; Yin, 2009) • CSE Framework (Yin, 1992; 2009): • Develop understanding of the program & combine with literature • Define units of analysis; Create timeline • Define measures, protocols, & procedures • Data collection, analysis, and synthesis; Compose a report • Reflection: Myself and Stardale stakeholders (i.e., staff)

  22. Phase 3: Test and refine the framework Research Question: • What can we learn by piloting the readiness assessment framework on an existing community-level intervention? • Pilot by Stardale staff and stakeholders • Semi-structure interview for framework feedback • Practicality • Function • Comprehension • Feedback re. strengths, weaknesses, gaps

  23. Establishing Validity • Experts (different from study 1) • Population health • Intervention research • Scaling up • Semi-structured interviews • Face validity • Content validity (main domains present) • Feedback re. strengths, weaknesses, gaps

  24. Phase 1: Scoping Review -Develop a Readiness Assessment Framework -Expert feedback and assess validity Phase 2: Case Study Evaluation -Greater understanding of a community-level intervention, Stardale Phase 3: Test and refine the framework -Assess its utility and practicality (Stardale) -Feedback & assess validity (Experts) Readiness assessment framework to assist stakeholders to determine if a health intervention is ready to scale up to a population-level intervention

  25. Select References Arksey, H. & O’Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1):19-32. Edwards, N. (2010). Scaling-up health innovations and interventions in public health: a brief review of the current state-of-the-science. Draft Paper Commissioned for the Conference to Advance the State of the Science and Practice on Scale-up and Spread of Effective Health Programs. Available from: http://ihiscaleupconference10.blogspot.com/2010/06/june-25-introductory-call.html Johnston, A. L. K. (2008). Aboriginal ways of knowing: Aboriginal-led evaluation. The Canadian Journal of Program Evaluation, 23(1), 1-6. Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science; 5:69. Available from: http://www.implementationscience.com/content/5/1/69 Mangham, L. J. & Hanson, K. (2010). Scaling up in international health: What are the key issues? Health Policy and Planning, 25(2): 85-96. doi:10.1093/heapol/czp066 Matheson, A., Dew, K., Cumming, J. (2009). Complexity, evaluation and the effectiveness of community-based interventions to reduce health inequalities. Health Promotion Journal of Australia, 20(3): 221-226. Uvin, P. (1995). Fighting hunger at the grassroots: Paths to scaling up. World Development, 23(6): 927-939. Yin, R. K. (2009). Case study research. California: Sage.

  26. Helpful Resources re. PHIR Methods Literature reviews: Bambra, C. (2011). Real world reviews: A beginner’s guide to undertaking systematic reviews of public health policy interventions. J Epidemiol Community Health, 65, 14-19. Grant, M. J. & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26, 91-108. Jackson, N. & Waters, E. (2005). Criteria for the systematic review of health promotion and public health interventions. Health Promotion International, 20, 367-74. Riaz, M., Sulayman, M., Salleh, N., & Mendes, E. (2010). Experiences conducting systematic reviews from novices’ perspective. Avail from: http://www.cs.auckland.ac.nz/~norsaremah/EASE2010.pdf Evaluation research: Hawe, P., Degeling, D., & Hall, J. (1990). Evaluation health promotion: A health worker’s guide. Australia: Elsevier. Weiss, C. H. (1998). Evaluation, 2nd ed. New Jersey: Prentice Hall. Qualitative research: Denzin, N. K. & Lincoln, Y. S. (Eds). (2011). The SAGE handbook of qualitative research. Thousand Oaks: SAGE. Merriam, S.B. (2009). Qualitative research: A guide to design and implementation. San Francisco: Jossey-Bass. Stake, R. E. (2010). Qualitative research: Studying how things work. New York: Guilford Press.

  27. Funding for my dissertation has been provided by the CIHR Population Health Intervention Research Centre PhDScholarship. Funding for my internship at the WHO has been provided by the CIHR Population Health Intervention Research Network Internship Scholarship. Thank You! Supervisors: Drs. Lynn McIntyre & Lindsay McLaren Supervisory committee and members of PHIRC at UofC Acknowledgements A CIHR Centre for Research Development in Population Health

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