Abstract
BackgroundEvaluation of the potential effectiveness of a programme’s objectives (health or otherwise) is important in demonstrating how programmes work. However, evaluations are expensive and can focus on unrealistic outcomes not grounded in strong theory, especially where there is pressure to show effectiveness. The aim of this research was to demonstrate that the evaluability assessment (a cost-effective pre-evaluation tool that primarily gives quick, constructive feedback) can be used to help develop programme and outcome objectives to improve programmes while they run and to assist in producing more effective evaluations. This was done using the example of a community development programme aiming to improve health and reduce health inequalities in its target population.MethodsThe setting was Glasgow, Scotland, UK and focused on the Health Issues in the Community programme. Data were collected from documents and nine individual stakeholder interviews. Thematic analysis and a realist approach were used to analyse both datasets and, in conjunction with a workshop with stakeholders, produce a logic model of the programme theory and related evaluation options to explore further.ResultsFive main themes emerged from the analysis: History; Framework; Structure and Delivery of the Course; Theory of Action; and Barriers to Delivery and Successful Outcomes. These themes aided in drafting the logic model which revealed they key programme activities (e.g. facilitating group learning) and 23 potential outcomes. The majority of these outcomes (16) were deemed to be short-term outcomes (more easily measured within the timeframe of an individual being involved in the programme) e.g. increased self-esteem or awareness of individual/community health. The remaining 6 outcomes were deemed longer-term and included outcomes such as increased social capital and individual mental health and wellbeing.ConclusionsWe have shown that the evaluability assessment tool can be applied to the evaluation of community health programmes, providing short- and long-term outcomes that could be evaluated to demonstrate effectiveness and avoid unnecessary or poorly designed full-scale evaluations. This type of pre-evaluation method is already a useful resource for national policy evaluations, but could be a valuable evaluation tool for other regional or community health programmes.
Highlights
IntroductionEvaluation of the potential effectiveness of a programme’s objectives (health or otherwise) is important in demonstrating how programmes work
Evaluation of the potential effectiveness of a programme’s objectives is important in demonstrating how programmes work
Stage 1 results: Themes The analysis of the documentary review and the nine stakeholder interviews revealed several emerging patterns pertaining to the Health Issues in the Community (HIIC) course that were organised into five broad themes and several further sub-themes (Fig. 2)
Summary
Evaluation of the potential effectiveness of a programme’s objectives (health or otherwise) is important in demonstrating how programmes work. Among the earliest British publications are the Black Report and the Acheson Report which detail that health inequalities are correlated with the social determinants of health such as age, gender, educational attainment, ethnicity, employment status, income level and geographic location [2,3,4] Such inequalities include discrepancies in Belford et al BMC Medical Research Methodology (2017) 17:70 work and in what contexts in order to be cost-effective and sustainable in terms of improving population health while reducing health inequalities. It is important to take into account both short-term objectives and bottom-up approaches (community and local-driven needs and actions) as a way of complimenting top-down approaches to help create long-lasting and sustainable change and effective polices [7,8,9] Such a community-based intervention from the UK that was developed with support from the public sector is Health Issues in the Community (HIIC), a community educational training programme based in Glasgow, Scotland and delivered throughout Scotland. The long-history of HIIC hints at effectiveness in terms of health improvement, but attributing effectiveness to a single programme in health improvement and reducing health inequalities can be difficult, which establishes the need for better designed evaluations [12]
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