Does Health Promotion Work?

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Does Health Promotion Work?

• Puja Myles

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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

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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

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Designing a health promotion intervention/programm
e-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

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Designing a health promotion intervention/programm
e-2

• Decide programme goals
• Monitoring
• -what will you monitor?
• -how often?
• Evaluation

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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?

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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.

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Evaluation perspectives-1

• Developmental/formative
• Process
• Summative
• -Outcome evaluation
• -Impact evaluation
• (Ovretveit, J.)

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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

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Health Outcomes
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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

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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

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Qualitative versus Quantitative

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

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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

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Health Outcomes?

• Self-confidence
• Self-efficacy
• Social involvement
• Sense of achievement/direction
• Stress relief
• Participation in social networks

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Special evaluation methods

• Audits
• Health Equity Audits
• Economic Evaluations

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Audit

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

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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!!

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Economic evaluation
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What is the question?

• Is this activity worthwhile?
• Is this an efficient way to achieve a particular
  outcome?
• Are the health benefits of this activity
  justified?
• What is the least cost way to achieve a given
  outcome?

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Allocative efficiency vs. technical efficiency

• Allocative efficiency
• cost-benefit analysis
• cost-utility analysis
• cost-consequences analysis
• Technical efficiency
• cost-effectiveness
• cost-minimisation

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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

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A dummies guide to

• bringing it all together

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Applying the PT-DES approach
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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

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PT-DESStep 1

• Involving stakeholders and developing programme
  theory
• Identify Relevant Stakeholders
• Develop common understanding of project context
  and objectives

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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)

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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

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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

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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

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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)