‘Old’ tools in a new era: unpacking the roles of promotional and informational resources in scaled-up preventive interventions

Abstract

ABSTRACT As health promotion as a field progresses further into the 21st century, it may seem backward-looking to devote research energy to the study of health information leaflets and program resources. However, the longevity of these tools in health promotion invites more critical understanding of their roles and meanings, particularly now in the era of scaled-up evidence-based programs. As program implementation becomes more complex, it is vital that we understand the roles these tools play, as ‘what’ it is about them that needs to be scaled-up might be misconstrued or contestable. We undertook a multi-sited ethnography of the electronic information management system used to assist the scale-up of a $45 m population wide childhood obesity prevention program in New South Wales, Australia. This provided a window to observe the roles of informational materials and program resources in program implementation in schools and early-childhood services. We found that resources acted both as a form of standardisation (controlling the form of the program across the state) and as a means by which practitioners developed flexibility in local-level adaptation. We found practitioners strategically harnessed program resources as tools to assist in relationship building, and to achieve key performance targets. Resources also played a crucial role in developing collaborative engagements between practitioners working in a range of local contexts across the state. We conclude that during program scale-up, there is a set of actions and interactions around program resources that illustrate and mirror wider implementation tensions and dynamics, revealing important small moments of practitioner agency.