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Evaluation framework: Promoting health through strengthening community action
Lori Baugh Littlejohns
& Neale SmithDavid Thompson Health Region,
Red Deer, Alberta
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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
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2 programs in DTHR to strengthen community action
Healthy Communities Initiative
Health Promoting Schools Initiative
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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.
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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.
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Why the framework:Evaluation picture
Safe & meaningful steps needed.
Simple data collection methods & tools required.
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Why the framework: Different pictures
Ongoing performance measurement
regularly reported established
expectations accountability
Evaluation as needed unintended impacts contextual factors “why” questions
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Evaluation framework:2 core concepts
Community capacity
Organizational capacity
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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)
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What are we building?
Shared visionParticipation LeadershipCommunicationOngoing learningResources, knowledge & skillSense of community
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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?
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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
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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
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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)
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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
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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
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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
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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?
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Where are we ...
Next steps:
Establish indicators for long term outcomes & performance measurement