Blending Participatory Action Synthesis and Meta-Ethnography: An Innovative Approach to Evaluating Complex Community Health Transformation

Kristin Reed,Caroline Chandler,Tara Carr,Jonathan Scaccia,Rumana Rabbani,Brittany Cook,Rohit Ramaswamy,Paul Howard

doi:10.35844/001c.29011

Abstract

Community health improvement processes are diverse and complex, and evaluation methods to gain generalizable knowledge across community settings are limited by available data, and the need for deep contextual knowledge. This article describes an innovative participatory approach to evaluation of a transformation initiative involving up to eighteen communities nationwide. The approach blends two qualitative research synthesis methods: participatory action synthesis and meta-ethnography and applies them to the pragmatic evaluation of a program in real-life settings. In this article, we present the justification for and details about the evaluation process. The approach presented here will be useful to both researchers and practitioners interested in evaluating community-based health and well-being initiatives and other complex interventions conducted in complex settings.

Highlights

Despite trillions of dollars in healthcare spending, the achievement of population health outcomes in the US has stagnated, and inequities in wellbeing continue to persist (Tikkanen & Abrams, 2020)
Since this paper focuses on the evaluation approach and not the results of the evaluation, for illustrative purposes we have selected data from two communities and one subgroup (Engaging People with Lived Experience) to show the outputs from the first three cycles of our process
The community engages people with lived experience in a number of roles, including as community champions, project leaders, trainers, organizers, key informants and participants throughout the course of the change process we show raw data from three sources for our two sample communities: (a) the project management system where program goals are set and progress is measured; (b) transcripts from community calls with their coaches; and (c) an interview with the implementation team during a routine project milestone call

Summary

Introduction

Despite trillions of dollars in healthcare spending, the achievement of population health outcomes in the US has stagnated, and inequities in wellbeing continue to persist (Tikkanen & Abrams, 2020). A complexity-informed approach recognizes that successful implementation in a complex system requires an appreciation for how interactions between multiple community-specific influencers affect outcomes and the development of processes that are responsive to unanticipated and emergent consequences that might arise. This requires the ability to test solutions through a series of sequential experiments, to evaluate how the system responds and making any context-appropriate adaptations based on the findings. These methods should promote the leadership of those closest to the data in interpretation, nurture relationships between and across communities, and accommodate changes in data, evaluation team membership and context as the initiatives evolve

Objectives

Results

Discussion

Conclusion