Process Mapping Tool for Evaluation SW UK Partnership

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1 Process Mapping Tool for Evaluation SW UK Partnership There are three areas of Recommendation developed by the work of the SW UK partnership. These are set out in the SW UK published Policy Analysis. They involve: Messages that represent the broad experience of stakeholders. Specific messages from particular stakeholder groups. Overarching cultural issues affecting all stakeholders. In each of these areas we suggest that policy and action should focus on the key points within them. In some cases, as the initial scoping and selfassessment processes found out, appropriate policies and indicative actions were already happening. In some areas there were gaps, either in policy or action or both. There is also the issue of clarifying precisely what actions fall within the remit of those involved and who decides that: national, sub regional, local, individual. This issue of responsibility is particularly complex, due to the political and social changes created by the current UK Coalition Government relating to health and social care and to the effects of the economic recession being experienced in the UK. The project s work has been a journey in pinpointing those areas where the pilot Trial Out work could develop meaningful activity that would achieve maximum, sustainable impact. Disclaimer: The contents of this document reflect the views of the author. The European Commission is not responsible The PoHeFa project is partly financed by the EU Public H l h P

2 Recommendation 1 from the Policy Analysis The project s work must be aware of the following Messages representing the broad experience of stakeholders: There are conflicting messages from health practitioners, the media, manufacturers and supermarkets regarding health, obesity and overweight. There is a lack of consistent guidance around portion size and calorific intake. There is a lack of information and skills for healthy cooking/meals preparation. In the overall public arena there is no clear and consistent representation of the economic, social and environmental cost of leading/not leading healthy and active lifestyles. Related Conceptual Paper factors: Healthy weight/excess weight is a complex phenomenon that ought to be reflected in health promotion politics and policy. (Conceptual Paper p. 5, 3.0). Whether parents/children/adolescents find themselves in a negative or positive health spiral varies according to a person s standard of living. (Conceptual Paper p. 5, 3.0). Parents/children/adolescents are part of many different social environments. (Conceptual Paper p.6, para 2). A political and administrative system has three overriding political measures: Regulation, creation of incentives and being informative. (Conceptual Paper p. 10, 4.1.1). it is essential that expert practice is differentiated in relation to the individual s preconditions and preferences in order to thereby increase his/her sense of meaningfulness in relation to the effect of the setting in question. (Conceptual Paper p.15, 5.2.2). 2 P age

3 Recommendation 2 from the Policy Analysis The project s work must be aware of the following Messages representing specific issues from particular stakeholder groups. In summary: Overweight as a social norm and lack of awareness regarding the appropriate weights for infants and children at different stages. Difficulties of communicating with people about their weight without it being perceived as an insult and damaging the future relationship with the health practitioner. Influence of different family generations and their perceptions of food breaking the cycle. Complex influences on children including parents / school / health professionals / media potentially all providing different messages. Role and responsibility of the GP/ health practitioner in informing and challenging patients about their weight. Concern over the helpfulness and approach of the National Child Measurement Programme. Importance of television for information and in shaping perceptions. Impact on mental health and the need for self esteem, building confidence and empowerment to make positive choices. By Stakeholder Group detail: Health Professionals messages, that: There are a range of barriers to accessing services e.g. timing, commitment, motivation and awareness. There are difficulties with particular members of the public reaching the right people, with gaps around those most in need and teenagers. The role of parents in influencing weight and understanding obesity is not sufficiently understood or acted upon. Health professionals need advice and support regarding how to get people to change through working with parents, school and media. Discussing obesity remains very challenging: it is the most contentious health issue and health professionals have considerable concerns over communicating with patients and barriers to discussion. 3 P age

4 Strategies are required for communication and management of overweight or obesity. The role of health professionals in supporting and informing people with weight issues has not been properly developed. There is a need for better education in preparing and recognising food. There are significant gaps in parents knowledge relating to obesity, e.g. around cooking; calorific values of different foods. There is a high level of complexity across the different types of action needed e.g. information provision; positive messages; focus on early years. Health professionals feel a high level of responsibility to address overweight and obesity. Parents messages, that: They need support and not just information. There is confusion around what constitutes the correct weight and is weight the right focus anyway? Coherent suggestions are required for useful information and activities. There are specific barriers to healthy lifestyles, for example the cost of food and exercise and safety and activities for young people. The role of health professionals in making time to support and inform people about obesity needs further emphasis. There are general perceptions of a lack of support and gaps in information around nutrition, healthy weight, overweight and obesity, and barriers to healthy and/or active lifestyles. There are varying views about the type, extent, and nature of communication needed to support actions on obesity. There are varying and inconsistent experiences of communicating with health practitioners. Information about portion sizes and the meaning of weight measurements is often contradictory and muddling. Young People s messages, that: The role of television programmes about weight is important. The responsibility of parents in influencing food and exercise choices is very variable. There are many reasons for being worried about obesity at a population level. Young people have valid views regarding what might make a difference in terms of clubs, walking to school, open days and recording / rewarding progress etc. There is a huge range of information sources about obesity, including television, internet, parents, and teachers. The diversity and nature of sources and types of information communicating about obesity to children are not well understood by adults. There could be improvements to the current types and levels of communication adopted by health organisations and scope for the greater practical involvement of children in the communications. Children also experience many barriers to healthy lifestyles e.g. cost, transport. 4 P age

5 Related Conceptual Paper factors: relevant key people include: health managers, leaders of child and adolescent administration, managing health nurses etc. Interviews with these key people will result in the following data... (Conceptual Paper p. 12, 4.2.2). Robert D. Putnam (2000) describes social capital as characterised by networks, norms, trust and reciprocity and differentiates between two different forms; delimiting and bridgebuilding social capital. (Conceptual Paper p. 16, 5.2.4). As learning theory prerequisites, bridge building and linking social capital are key concepts in relation to the individual s possibility to improve his/her health and it is important therefore that the health related pedagogical practice actively contributes to children, youths and adults participating in communities across social divides and that the same practice is aware of the power structures inherent in the community in order to promote the equal participation of individuals in low positions. (Conceptual Paper p.17, 5.2.4). 5 P age

6 Recommendation 3 from the Policy Analysis The project s work must be aware of the following Messages representing overarching cultural issues affecting all stakeholders: Social and cultural change appears to adjust what constitutes NORMAL and ACCEPTABLE in regard to overweight and obesity. This means that conditions that at one point would constitute being overweight and obese later become adjusted to constitute a social norm and become acceptable and therefore more difficult to challenge. Public Health services need to acknowledge that underpinning successful action on obesity is the capacity to communicate effectively, through the most appropriate medium and registers. The capacity to manage this is highly challenging, in an increasingly complex communications world and on an issue that itself is a complex phenomenon. The culture of more for less and focus on localism resulting from the political and social changes created by the current UK Coalition Government and the economic recession being experienced in the UK are resulting in an intricacy of changes and cutbacks that are yet to be fully understood in the areas of health and care services. Related Conceptual Paper factors: health is the ability to fulfil an objective and that which is crucial to an individual s health their capacity to act is the relationship between the individual s objective, the conditions of their life and their ability and capacity to act (ibid.). This definition incorporates standard of living as an essential element of health. (Conceptual Paper p. 3, 2.0). the objective of health promotion is to advance individuals and/or groups in their ability to take action. If this dimension is featured in Jensen s definition of health the individual s capacity to act will be of pivotal significance. (Conceptual Paper, p. 4, 2.0). A myriad of different environments influence an adults/child/adolescents health. If few (1 2) of these environments are studied, the outcome on health will be limited. (Conceptual Paper p.6, 3.0). 6 P age

7 Recommendation 4 from the Policy Analysis The project s work must be aware that the following strategic points set out how society more widely could respond sustainably to obesity and contextualise the stakeholders messages: Most adults in the UK are already overweight. Modern living ensures every generation is heavier than the last `Passive Obesity. By % of men and 50% of women in the UK could be clinically obese. Without action, obesity related diseases are estimated to cost society 49.9 billion per year. The obesity epidemic cannot be prevented by individual action alone and demands a societal approach. Tackling obesity requires far greater change than anything tried so far, and at multiple levels: personal, family, community and national. Preventing obesity is a societal challenge, similar to climate change. It requires partnership between government, science, business and civil society. Related Conceptual Paper factor: The relationship between social position, i.e. the socio cultural context in which the individual acts and is a part, and the individual s health, is an important focus in the project. (Conceptual Paper p.7, 3.2). 7 P age

8 Goal descriptions for Trial Out Pilot Goal 1 To develop a dedicated toolkit to support the senior public health workforce to make the case for continued or new investment in childhood obesity. The final toolkit will give practical examples of how childhood obesity programmes could impact on the strategic priorities within municipalities. Expected results: Short term (within 3 months): action plan to develop elected member briefing methods. Medium term (within 6 months): production, evaluation and hosting of dedicated resource/toolkit. Long term (1 2 years of close of PoHeFa project): dissemination and adoption at national level of resource/toolkit product; and integration with resources produced by North East Public Health Observatory and National Obesity Observatory. Interventions and decisions: The following stages were involved in the decision making processes and the consequent key actions taken: June 2011: SW UK partners draft Action Plan. July September 2011: South West Public Health Observatory research and scoping existing resources re prioritization of child obesity. August September 2011: Elected members meetings and interviews conducted. September 2011: Research and interview summaries. September 2011: SW UK partners Revised Action Plan. September December 2011: Research and negotiation with National Obesity Observatory (NOO) re resources production October 2011: Commencement of formative dissemination and evaluation process with input to UK Health Literacy Group Seminar Strategic Approaches to Health Literacy. January 2012: SW UK partners meeting review and approval of progress report. January February 2012: Involvement negotiated of North East Public Health Observatory, with additional funding provided to co develop Obesity Local Authority Toolkit. 8 P age

9 February 2012: Specification for Obesity Local Authority Toolkit and web based hosting. February 2012: SW UK partners meeting review and approval of progress report. March 2012: Production of draft Obesity Local Authority Toolkit. March 2012: Formative dissemination and evaluation process with input to Obesity Commissioning Conference Commissioning Services to prevent and treat obesity during transition and beyond. April May 2012: Evaluation and editing of Obesity Local Authority Toolkit and live hosting on North East Public Health Observatory (NEPHO) website. May 2012: SW UK partner meeting for final evaluation process and action planning post PoHeFa sustainability for Obesity Local Authority Toolkit dissemination and adoption. Goal 1 Results Short term Review of key messages from focus groups Draft action plan for Trial Out pilot. Research on currently available resources. Public Health and Obesity Observatories involvement. Councillors meetings/briefings. Local Authority sign up. Specification of required resources for Obesity Local Authority Toolkit. Medium term Production of Obesity Local Authority Toolkit. Formative dissemination and evaluation through regional/national conferences. Alliance with North East Public Health Observatory and National Obesity Observatory to host and promote Obesity Local Authority Toolkit. Long term The long term results of the work are not yet known, but the foundations for the achievement of the stated Goals are in place, with: The initial production and web hosting of the resources. The involvement of Public Health Observatories at regional level and the National Obesity Observatory at national level. The co operation of pilot Local Authorities on the issue of support to the senior public health workforce to make the case for continued or new investment in childhood obesity. 9 P age

10 Goal 2 To develop a programme of brief advice and brief intervention training methods and resources to support continuing professional development of health and other services (for example, emergency services) professionals. Expected results: Short term (within 3 months): action plan to: scope existing training resources develop and trial brief advice and brief intervention training sessions; obtain evaluation feedback; develop draft training pack. Medium term (within 6 months): incorporation of brief advice and brief intervention training into wider training delivery; trialling and evaluation; scoping wider usage across health and other service professionals groups. Long term (1 2 years of close of PoHeFa project): dissemination and adoption of training methods and resources across new public health arrangements at local authority level. Interventions and decisions: The following stages were involved in the decision making processes and the consequent key actions taken: June 2011: SW UK partners draft Action Plan. June September 2011: Review of current brief advice and brief intervention training packs. September 2011: SW UK partners Revised Action Plan. September October 2012: Adaptation of resources for health professionals to meet the needs of obesity programme and local areas. October 2011: Commencement of formative dissemination and evaluation process with input to UK Health Literacy Group Seminar Strategic Approaches to Health Literacy. January February 2012: 4 trial brief advice and brief intervention training sessions run and evaluated. March 2012: Training adapted from heath professional feedback. 10 P age

11 March 2012: Formative dissemination and evaluation process to a range of stakeholders including elected members and public health specialists with input to Obesity Commissioning Conference Commissioning Services to prevent and treat obesity during transition and beyond. March April 2012: Training resources revised and written up, to include the development of train the trainer resources. May 2012: Completion of brief advice and brief intervention training pack, with guideline for trainers, available on line. May 2012: SW UK partner meeting for final evaluation process and action planning post PoHeFa sustainability for Obesity Local Authority Toolkit dissemination and adoption. Goal 2 Results Short term Review of key messages from focus groups Draft action plan for Trial Out pilot. Sign up of local authorities and health professionals groups. Review of current brief advice and brief intervention packs. Adaptation of resources for health professionals. Pilot training sessions and evaluation reports. Re specification of training resources and methodology. Medium term Training adapted from heath professional feedback Wider adoption of training by health professionals and emergency services. Addition of resources support for training the trainers of brief advice and brief intervention delivery. Development of online hosting for training resources. Long term The long term results of the work are not yet known, but the foundations for the achievement of the stated Goals are in place, with: The initial production of the resources and confirmation of its wider applicability, beyond health professionals to include emergency services staff. The wider distribution and uptake of the resources through online availability. The wider co operation of Local Authorities with their new Public Health responsibilities on the issue of support through the availability of effective brief advice and brief intervention training relating to obesity. 11 P age

12 All actions taken to meet both the Goals of the SW UK Trial Out work have operated within a longer term context of: Health Improvement in England moving to local authorities control and the development not being about the same programmes being offered from a different organisation, but a complete transformation of the delivery agenda. Required change from silo driven local policies to collaboration and cofunding, requiring a substantial cultural shift and new skills and experience on the part of health professionals and also elected members. Advocating an assets based approach to public health, including obesity, that works alongside more traditional approaches to community based development, working on the principles of: appreciating and mobilising individual and community talents, skills and assets (rather than focusing on problems and needs); community driven development rather than development driven by external agencies. Considering how Social Return on Investment (SROI) methods can be used to demonstrate the wider value of delivering health and social care services through social enterprise. 12 P age

13 Goal 1 the values and results experienced by: Management and administration level The resources support how obesity issues and prioritisation fits into other policy concerns: planning, transport, environment health, highways, education, workplace health etc. The resources approach in providing cabinet report templates for obesity enables a consistent approach to briefing. While the UK Coalition Government s Big Society & local determination agendas require substantial cultural changes for the organisations concerned, economic constraints means that there is little being invested to support & develop skills to enable this. The generic approach of Goal 1 provides low cost, wide reach access to resources to support co working/co funding approach to obesity prioritisation. Professional practitioners Resources and methodology has a development track record of service user involvement and health professional feedback. The access to and currency of the resources are strengthened by being available on line. Achieving long term prioritisation for obesity programmes will be difficult. The Goal 1 resources will support action to increase the wider knowledge base for prioritisation. Other stakeholders Have benefitted from direct involvement in the prioritisation of the Trial Out work through focus group and evaluation work. 13 P age

14 Goal 2 the values and results experienced by: Management and administration level Benefit from the brief advice and brief intervention training techniques and resources being embedded in wider continuing professional development. While the UK Coalition Government s Big Society & local determination agendas require substantial cultural changes for the organisations concerned, economic constraints means that there is little being invested to support & develop skills to enable this. The generic approach of Goal 2 provides low cost, wide reach access to resources to support co working/co funding approach to obesity prioritisation. Achieving long term prioritisation for programmes such as obesity will be difficult. The Goal 2 resources will support action to support the wider knowledge base for prioritisation. Professional practitioners Value of the resources hands on and interactive approach. The resources and brief advice and brief intervention methodology is applicable for a wide range of health and other professional services. Resources and methodology has a development track record of service user involvement and health professional feedback. The access to and currency of the resources are strengthened by being available on line Other stakeholders Have benefitted from direct involvement in the focussing and prioritisation of the Trial Out work through focus group and evaluation work. Simon Mauger, on behalf of the SW UK partnership May P age

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