Conceptualising the societal value of health and wellbeing and developing indicators for assessment

Abstract

Background Contemporary health promotion interventions commonly adopt community-based approaches to address health and social problems. Evaluating their outcomes is challenging because of the complex and reciprocal relationship between individual behaviour and wider environmental factors. It is important for public health organisations to understand the wider societal impacts of their interventions and the journey of change that can unfold for stakeholders as they engage with programmes. A theory of change is first developed for a community health intervention from which a number of indicators to assess health and wellbeing outcomes are developed. Methods Participants (n = 34) were recruited from a sample of community stakeholders who had acquired local government funding to deliver health promotion projects. Via qualitative storyboard workshops and individual face-to-face interviews, participants identified the anticipated short, medium and long-term outcomes of their projects. Data were collected via a journey of change template and discussions were recorded and transcribed verbatim. Data were interrogated using a grounded theory methodology from which a theory of change was developed to provide a temporal map of the outcomes and the relationships between them. Results The theory of change identified three distinct conceptual pathways describing the nature of trajectories articulated by stakeholders, the conditions surrounding actions within these pathways, and the main outcomes of the programme. These included improved health, wellbeing, community cohesion and agency, for which a range of indicators of change were developed. Conclusions The conceptual framework developed via a grounded theory of change methodology provides a powerful means of unpacking the complex phenomena of health promotion interventions. Together with the developed indicators of change this represents an innovative approach for the evaluation of community health initiatives. Key messages The conceptual framework helps to understand the wider societal impacts of health promotion interventions which are often neglected due to methodological constraints The indicators of change provide a means of assessing the wider societal value of health and wellbeing in community settings