Principles of Public Health Practice/Funding and evaluating public health interventions

Part of being a public health practitioner is ensuring that your program can gain funding or regain funding. Funding bodies want to know what works and how it works in various contexts. The video playlist will cover the basics about program evaluation and funding. They will identify a number of key issues and concerns. Additionally, they will help you know why we are motivated to evaluate our work. It is about the funding; but, the funding is about the people whose lives will change as a result.

Learning activity instructions

Each week we hold a lectorial and a tutorial. A lectorial is a short lecture followed by a group activity, and the tutorials are for discussion and practising group activities.

Lectorial

View the playlist here.
Review the introductory story and background information and scan the references and resources.
Attend the lectorial.

Tutorial

Download the workshop sheet
Progress your third assessment which is the development of a five minute recorded presentation for delivery and discussion in weeks 10, 11 and 12. You will need to turn in as per the instructions on LMS by 9 a.m. on the 26th of May 2014.
Attend the tutorial session to discuss the presentation and ensure that you have negotiated with your group about which vulnerable group you will be orienting your presentation towards.

How might various approaches to evaluation and the concerns of funding bodies shape public health practice and why?

Suppose that you and your friends decide to travel to Bali for a vacation. Each of you will have different ideas about what you would like to do and what would make the trip valuable. You will probably also each have your own ideas about how much you are willing to pay for the trip. Your initial ideas will surely need further investigation. You will need to do this so that you can create a shared plan.

So, a couple of you might drop into a few travel agencies to see what sort of vacation plans they might offer. You will, no doubt, look up the Department of Foreign Affairs and Trade web-site to see the various options and warnings that they have published. You note that you are encouraged obtain certain vaccinations or take various precautions before travelling. You also study various books on travelling to stay abreast of the latest techniques for protecting your valuables. You will even find out how to get the best value from your mobile phone account. You will likely purchase travel insurance and someone in the group will even investigate what to do in case of a medical emergency or a natural disaster.

With each new round of information gathering, you ask whether you have all the right answers to your earlier questions. This is because you have a better understanding of the issues. At some point, you will have purchased your tickets and found yourself at the airport on your way to Bali. You can assess how well you did in terms of the process of planning and organising your trip as you go along. The more you anticipated difficulties and planned for them, the less you will have to worry about later. But, one of your friends was right; there is no sense in making yourself sick trying to think about everything.

At some point, you just have to act. However, you quickly discover why preparation counts. It may have cost you a little to begin with and one or two of the group might have wanted to cut costs. But, when one of your group gets food poisoning and needs hospitalisation, everyone is happy that you did your homework. So, you can evaluate the process of getting there and the attendant costs. You will continue to evaluate the fun you are having and the costs at each new event and experience. You are paying attention to all the little impacts along the way. On the flight back, each of you may be tired; but, you will probably think about the overall impact of the trip. Were there too many sunburns, too few good times, too many cheap souvenirs and so forth.

Months later, when someone else is thinking about going to Bali, the overall outcome of your trip might incline you to encourage their curiosity. You might urge them to take a similar or, even, a somewhat different trip. Or, you might list all of the costs and decide that you would have had just as much fun at Torquay for far less expense. If family members or friends helped you with the finances, they may have shaped what you decided to do and your overall sense of the value of your holiday. If you borrowed money on your credit card and you could not afford to do anything else for six months, you might end up having a very different evaluation of the benefit of the trip much later. This would be another form of outcome evaluation.

Background

Too often, evaluation takes a very low priority in project planning. This is unfortunate. If the evaluation is tacked on at the end, valuable information and insights are likely to be lost. The participants in the project will be flying blind in terms of what is really happening along the way. Fortunately, most of us have some very basic evaluation criteria that we use to determine whether we are doing the right thing and getting the right results.

However, what works for us as individuals on a common sense basis during our day to day living is not truly adequate. By failing to make our criteria explicit, we miss the opportunity to improve on our evaluation practice. We also diminish our capacity to both work with and convince others of the significance of what we are doing. In the end, if we cannot persuade others of the effectiveness and efficiency of our actions, they are unlikely to sustain their commitments to providing resources.

There is another dimension to funding and evaluation besides effectiveness and efficiency. Equity is a crucial dimension. Equity is about justice which is about ensuring that each person gets what is do them as a human being. But, there is more too equity. Sometimes the normal rules and standards, which we need to work together well with others, do not work well for some people in certain circumstances. In these cases, equity goes beyond simple justice. Think of public transportation. Normally, we expect people to behave in a certain way. However, we make exceptions for the elderly, the less mobile and for those who are unfamiliar with our customs.

To learn more about a common language and approach to evaluation that is used by funding bodies the world over, please take the time to review the W.K. Kellogg Foundation's evaluation handbook. For more specific health in considering the impacts of health promotion aspects of public health, two Victorian resources can help you to better understand how integrated health promotion is both more effective and often more efficient. Further information on the appropriate types of evidence and their use can also be obtained at the Victorian site whose link is listed below.

Australians have been at the forefront of health promotion practice for a long time. Hawe, et alia, have published a classic text on health promotion that focuses on workforce development. It is nearly twenty-five years old. However, it is still very useful and can be obtained from such suppliers as the Advanced Book Exchange (Abebooks). If you cannot find a copy or you are low on cash, there is a very useful resource listed below at the Health Knowledge site in the UK. The health promotion evaluation link is a critical resource that you should not overlook.

References and Resources

International standard:

W.K. Kellogg Foundation Evaluation Handbook (pdf)

http://www.wkkf.org/resource-directory/resource/2006/02/wk-kellogg-foundation-evaluation-handbook

Two important Victorian documents:

DHS (2003) Measuring health promotion impacts: A guide to impact evaluation in integrated health promotion. Melbourne: Rural and Regional Health and Aged Care Services Division, Victorian Government Department of Human Services.

http://docs.health.vic.gov.au/docs/doc/9CF1F628F2BE470FCA257A7F0022825E/$FILE/measuring_hp_impacts.pdf

PPHB (2010) Evaluation framework for health promotion and disease prevention programs. Melbourne: Prevention and Population Health Branch, Victorian Government Department of Health.

http://docs.health.vic.gov.au/docs/doc/AE7E5D59ADE57556CA2578650020BBDE/$FILE/Evaluation%20framework%20for%20health%20promotion.pdf

You can obtain more documents like the above from the following site:

http://www.health.vic.gov.au/prevention/evidence/evaluation-tools.htm

IMPORTANT RESOURCE (it draws on work of Hawe, et alia, below). The next two links relate to the online Public Health Textbook provided by the Public Health Action Team of the Department of Health in the UK. It is one of the few online resources that can be used credibly.

http://www.healthknowledge.org.uk/public-health-textbook/disease-causation-diagnostic/2h-principles-health-promotion/health-promotion-evaluation

http://www.healthknowledge.org.uk/public-health-textbook

Classic Australian text:

Hawe, P. Degeling, D. and Hall, J. (1990) Evaluating Health Promotion: A health worker’s guide. Sydney: MacLennan and Petty.

Learning Outcomes

How might various approaches to evaluation and the concerns of funding bodies shape public health practice and why?

Upon completion of this topic, through your own investigations, group preparation, tutorial participation and lectorial explorations, you should be able to:

Relate the various issues involved in assessing a situation or circumstance with the view of preparing a public health intervention.
Explain the substantive reasons for conducting process evaluations of a public health intervention and identify potential stakeholder concerns.
Outline the strengths and limitations of engaging in impact evaluations of public health interventions and articulate arguments justifying their use.
Describe the how the various activities within a system might confound the outcome expectations and predict what this might mean in terms of future resource allocation.