Evaluation framework: Promoting health through strengthening community action Lori Baugh Littlejohns & Neale Smith David Thompson Health Region, Red Deer, Alberta

Ottawa Charter for Health Promotion §One strategy: strengthen community action §Importance of concrete and effective community action in setting priorities, l making decisions, l planning strategies, & l 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 picture §Community 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 l regularly reported l established expectations l accountability §Evaluation l as needed l unintended impacts l contextual factors l “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 vision §Participation §Leadership §Communication §Ongoing learning §Resources, knowledge & skill §Sense 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 l Planning activities (benefits of process: e.g., shared vision) l Outputs (utility of product: e.g., vision) l Implementation of action plan (s) §Long term l community-level and school-level indicators (e.g., participation) l track and monitor measurable changes in community capacity

Short term: Tools for evaluation § Activities l Description, why, participation, collaboration, outcomes (e.g., core group, visioning). l Building understanding of health, building capacity for leadership, etc. §Process l Choose a number between 1 (low) - 5 (high) & explain. l 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

Change in organizational capacity: Outcomes §Short term l Org commitment to supporting community action l Resources to make it possible... l Org structures that make it possible... l Behavioral processes or internal climate that models... §Long term l Integration/system alignment: goals & objectives are understood, integrated, & coordinated l Improved health and well-being: evidence from monitoring

Short term: Example §Organizational commitment l There is a shared understanding of what the community action team can achieve l There are champions of community action at the Authority and Senior management level

Short term:Tools for evaluation §Activities l 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 l 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