Evaluation framework: Promoting health through strengthening community action

Lori Baugh Littlejohns

& Neale SmithDavid Thompson Health Region,

Red Deer, Alberta

Ottawa Charter for Health PromotionOne strategy: strengthen community actionImportance of concrete and effective

community action in setting priorities, making decisions, planning strategies, & implementing them to achieve better health.

WHO, 1986

2 programs in DTHR to strengthen community action

Healthy Communities Initiative

Health Promoting Schools Initiative

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.

Why the framework:Practice pictureCommunity 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.

Why the framework:Evaluation picture

Safe & meaningful steps needed.

Simple data collection methods & tools required.

Why the framework: Different pictures

Ongoing performance measurement

regularly reported established

expectations accountability

Evaluation as needed unintended impacts contextual factors “why” questions

Evaluation framework:2 core concepts

Community capacity

Organizational capacity

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)

What are we building?

Shared visionParticipation LeadershipCommunicationOngoing learningResources, knowledge & skillSense of community

Community Assessment

Formation of Core Groups

Visioning

Selection of Key Priority Areas

Action Planning

Responsive?

Satisfaction with the process?

Perceived benefits of process?

Core Group

Vision

Community Profile

Key Priority Area(s)

Action Plan(s)

Implementation of Actions and Action Plan(s)

Effective? Efficient? Participation and partnerships?

change in community capacity

Adherence to principles?

Responsive?

Satisfaction with the process?

Perceived benefits of process?

Adherence to principles?

Responsive?

Satisfaction with the process?

Perceived benefits of process?

Adherence to principles?

Responsive?

Satisfaction with the process?

Perceived benefits of process?

Adherence to principles?

Responsive?

Satisfaction with the process?

Perceived benefits of process?

Adherence to principles?

Change in community capacity:Outcomes 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

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

Organizational capacity

“the potential ability of a health organization to develop an empowering and democratic partnership with a community, through which the community’s capacity to identify and address health concerns is strengthened”

K. GermAnn (2000)

Building organizational capacity: Examples from logic model

Inputs Activities Outputs Reach Outcome(short)

Outcome(long)

facilitators skill dev cohesiveteams

Dthrmgmt

grants culture shared

visioncomleaders

contracts wpartners

info schoolboards

networks # schools media

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

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

Short term:Tools 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 staff’s understanding of HCI/HPSI process?

Where are we ...

Next steps:

Establish indicators for long term outcomes & performance measurement