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Annex 1 Have a Heart Paisley Learning From
Phase 1 - Independent Evaluation
Phase 1 of
HaHP was subject to both external,
independent evaluation and internal, project based
monitoring and evaluation. This section outlines how
learning from the independent evaluation is being applied
in Phase 2 of the project.
There is much to be learnt from Phase 1 but not all is
relevant to the more focussed Phase 2 plans. This section
does not therefore detail all Phase 1 lessons. For a
detailed description of these (including learning from the
internal evaluation), please see the learning templates
available from the Heart Health Learning Network website (
www.healthscotland.com/hearthealth).
Similarly, the section does not try to identify every Phase
1 lesson that may be of relevance as it could be argued
that most are being addressed, at least in part, in Phase 2
and given the depth of information available, this would
lead to a particularly large section. For the sake of
brevity therefore, the section draws on the independent
evaluation learning templates and the various independent
evaluation reports to identify the main relevant lessons
from Phase 1 and outlines how these are being addressed in
Phase 2.
Applying Independent Evaluation Lessons from
Phase 1
Phase 1 Learning
HaHP activities need to be tailored to
the right residents/groups (Blamey et al, 2004
)
Phase 2 Action
At the individual level, the Health Coaches will
identify specific need and tailor advice and support
accordingly. At a more group orientated level, the initial
mapping and needs assessment exercise will identify where
gaps in services exist. Working with project partners,
HaHP will then seek to fill these
gaps.
Phase 1 Learning
There were high rates of referrals (for those with
identified
CHD risk factors) to smoking cessation
projects and services, fewer to exercise projects and
hardly any to community food projects. Furthermore, the
majority of referrals were made to
HaHP services as opposed to community
run projects. There are seen to be some lost opportunities
in developing links with the community projects (and
locality network coordinators) that are available
(Blamey et al, 2004
)
Phase 2 Action
The Health Coaches will act as intermediaries between
primary care,
HaHP and partner led services and the
community. This should lead to higher referral rates for
all services based on individual need and should maximise
the potential input from partner agencies and community and
voluntary groups.
Phase 1 Learning
On the whole
HaHP has remained on the periphery of
all the key partner agencies work and made little
contribution to the wider community planning agenda
(Blamey et al, 2004
)
Phase 2 Action
In Phase 2,
HaHP will be actively engaged in the
community planning agenda, designing and delivering
services with and for the local community.
Phase 1 Learning
Evidence-based practice (as understood from a medical
or health service perspective) was applied to a degree at
the conceptual level across most of
HaHP. However, there were areas of
operational practice where the application of evidence or
"best practice" was variable or non-existent (Blamey
et al, 2004
)
Phase 2 Action
Phase 2 has utilised the
RE-AIM planning tool to develop relevant
and appropriate programmes. This tool helps to identify and
apply the most up-to-date and applicable evidence. In
addition, Phase 2 will focus on areas where there is the
strongest evidence of effectiveness (
i.e. primary prevention in high-risk groups
and secondary prevention).
Phase 1 Learning
Many of the problems around the use of evidence,
intervention intensity and scope for saturation had their
roots in the early planning phases of the project and
resulted from a lack of early scrutiny from both the
SE and
HaHP of the range of plans submitted by
different agencies (Blamey et al, 2004
)
Phase 2 Action
Phase 2 has utilised a number of planning and evaluation
tools (
e.g.LEAP For Health and
RE-AIM) to develop relevant and
appropriate programmes. In addition, the project has
employed the services of an external consultant to assist
in project planning through the identification of relevant
strategy maps and associated targets and performance
indicators.
Phase 1 Learning
The internal evaluation of
HaHP experienced a range of
difficulties. These included: problems in recruiting
and retaining staff; the lack of relevant data that can
be disaggregated to a local level for use as a
baseline, the poor response rate achieved in the
external baseline survey, confusion over monitoring and
evaluation roles and delays in prioritising the key
focus of the internal evaluation (Blamey et al,
2004)
In addition, according to the final independent
evaluation report
:
it is vital that evaluation is considered from the
outset in any future pilot initiatives and that priorities
for key areas of evaluation are agreed and monitoring
processes subsequently focused towards these priorities. It
is also important that internal and external evaluation
roles are clearly defined and that monitoring is seen as
the responsibility of those running programe. (Blamey
et al, 2004
)
Phase 2 Action
Phase 2 has utilised a number of planning and evaluation
tools (
e.g.LEAP For Health and
RE-AIM) and employed the services of an
external consultant to identify a series of targets and
performance indicators that will be used to monitor and
evaluate the success of the project.
Phase 1 Learning
The lack of available internal monitoring data makes it
impossible to gauge
HaHP's success in saturating Paisley
with services and opportunities for health improvement or
reducing inequalities. Although many areas of
HaHP appear to be engaging with their
key target groups, the frequency, quality, duration and
health impact of this engagement has not been
established (Blamey et al, 2004
)
Phase 2 Action
As outlined above, Phase 2 of the project will ensure
all appropriate monitoring data is captured. In addition,
key factors of saturation are reach/coverage (no.
participants), intensity (quality and extent of
participation), adoption (no. of organisations
providing/participating in opportunities) and dose
(interaction of intensity, frequency and duration). The
RE-AIM framework, applied in Phase 2
planning, addresses many of these issues.
Phase 1 Learning
Short-term population interventions are unlikely to
reach enough members of the public, to deliver intense
enough interventions or to fully engage enough community
members in their design delivery or evaluation,
particularly if they fail to allow adequate time for
consultation of evidence and effective planning. It appears
increasingly evident that dramatic change will not be
achieved by such short-term interventions unless they are
given feasible timescales and genuine national support to
deliver and to fully engage local communities. The types of
changes achieved in the more successful of the
CHD or chronic disease interventions
projects resulted from intense activity with small
high-risk sub-groups or from long-term community and
advocacy to tackle upstream policy issues with the direct
support of central government (Blamey et al, 2004
)
Phase 2 Action
Dimension A of Phase 2 will target a high-risk sub-group
with an intense range of activities.
References: Blamey, A., Ayana, M., Lawson, L.,
Mackinnon, J., and Judge, K. Final Report for the
Independent Evaluation of
HaHP. Glasgow: Health Promotion Policy
Unit, University of Glasgow; 2004.
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