Framework for Evaluating Health Promotion projects: The Swiss Model for Outcome Classification in Health Promotion and Prevention (SMOC)
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Framework for Evaluating Health Promotion projects: The Swiss Model for Outcome Classification in Health Promotion and Prevention (SMOC) Committee on Valuing Community-Based, Non-Clinical Prevention Policies and Wellness Strategies Institute of Medicine, Washington, D.C. , 5 th December 201 1 Brenda Spencer University Institute for Social and Preventive Medicine, Lausanne Günter Ackermann Health Promotion Switzerland
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Framework for Evaluating Health Promotion projects: The Swiss Model for Outcome Classification in Health Promotion and Prevention (SMOC)
- 1. Framework for Evaluating Health Promotion projects: The Swiss Model for Outcome Classification in Health Promotion and Prevention (SMOC) Committee on Valuing Community-Based, Non-Clinical Prevention Policies and Wellness Strategies Institute of Medicine, Washington, D.C. , 5 th December 2011 Brenda Spencer University Institute for Social and Preventive Medicine, Lausanne Günter Ackermann Health Promotion Switzerland IUMSP Institut universitaire de médecine sociale et préventive, Lausanne
- 2. The SMOC in 2 phrases: Ø structured framework offering a common language to describe pathways to health Ø methodology developed for interactive use integrates the perspectives of all stakeholders Ø Plan of presentation § Why and how was this model developed? § What is the purpose and context of its use? § What is its theoretical basis and structure? § How is the model applied in practice? IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 2
- 3. The Swiss Model for Outcome Classification in Health Promotion and Prevention (SMOC): Plan of presentation § Why and how was this model developed? § What is the purpose and context of its use? § What is its theoretical basis and structure? § How is the model applied in practice? IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 3
- 4. Our ever-faithful friend, the black box Why we think our Our activities can goal lead to our goal Measures applied: What we do Improvement of a population‘s •Projects health •Programmes •Strategies •Policies n.b. output is not outcome! IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 4
- 5. It’s never so simple… Not possible to Not desirable to standardise standardise measures measures – adaptation to context What’s more, the Measures context changes over applied: time Improvement of a population‘s •Projects health •Programmes Most of these changes •Strategies you cannot predict •Policies And once they’ve And even if you could, you taken place, you’ll couldn’t control them need to take different IUMSP measures Institut universitaire de médecine sociale et préventive, Lausanne 5
- 6. Various ways to open the black box… IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 6
- 7. A new solution…………….? "Looks like the research boys really came up with something this time." IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 7
- 8. SMOC Development § 2002-2004: Model Construction § 2004-2005: Feasibility testing & Translation § 2005 onwards: Dissemination ØGuidelines for use http://www.gesundheitsfoerderung.ch/pages/Gesundheitsfoerd erung_und_Praevention/Tipps_T ools/ergebnismodell.php § 2008: Publication in Health Promotion International ØSpencer B, Broesskamp-Stone U, Ruckstuhl B, Ackermann G, Spoerri A, Cloetta B. et al. 23 (1): 86. http://heapro.oxfordjournals.org/cgi/content/full/dam038?ijkey= zQDCckIz8KuMxob&keytype=ref IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 8
- 9. The Swiss Model for Outcome Classification in Health Promotion and Prevention (SMOC): Plan of presentation § Why and how was this model developed? § What is the purpose and context of its use? § What is its theoretical basis and structure? § How is the model applied in practice? IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 9
- 10. Three types of application Situation analysis Where is a specific problem to be located? How may the problem have arisen? Intervention planning T o which categories can the factors contributing to the development of the How can the health of the problem be attributed and how do they relate population be maintained or how can a to each other? health-related problem be reduced? Are there other players that may already be having an impact? In which categories should the project’s objectives be situated and how do the objectives interact? Evaluation Which factors have contributed in which way to maintain health or reduce health- Applied at three levels: related problems in the population? In which categories have results ØProjects been achieved and how do these results ØProgrammes interact? What do these results tell us about our ØStrategies hypothesised theory of action? IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 10
- 11. The Swiss Model for Outcome Classification in Health Promotion and Prevention (SMOC): Plan of presentation § Why and how was this model developed? § What is the purpose and context of its use? § What is its theoretical basis and structure? § How is the model applied in practice? IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 11
- 12. The determinants of health Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Stockholm: Institute for Future Studies; 1991. IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 12
- 13. Theoretical and Methodological underpinnings and links § Field of Health: § Ottawa Charter, 1986 § Don Nutbeam, 2002; NIGZ Health Promotion Framework Saan & de Haes 2005; PRECEDE-PROCEED Green & Lewis, 1986; EUPHID Health Development Model for the classification of public health indicators Bauer et al., 2006 § Programmme Theory in Evaluation § logic model - “graphic depiction of the relationship between the main strategies of a program and associated goals, objectives, population(s) of interest, indicators and resources” (Hyndman et al., 2001) IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 13
- 14. Swiss Model for Outcome Classification Health promotion Factors influencing Health Health status of the measures (A) health determinants (B) determinants (C) population (D) Infrastructures A1: Development B1: Health services of services promoting services C1: Physical environment Legal system A2: Advocacy B2: Public policy Administration Networking and organisational Organisation Networks organisations practice C2: Social environment D:Health Groups A3: Social B3: Social potential Communities Population mobilization and commitment C3: Indiv. resources/ behavioural patterns Individuals A4: Development B4: Individual of individual health-related life IUMSP skills skills Institut universitaire de médecine sociale et préventive, Lausanne 14
- 15. SMOC: Levels of outcome (columns) and focal points Health promotion Factors influencing Health Health status of measures (A) health determinants (B) determinants (C) the population (D) Infrastructures, services Legal system, administration, organisations Health Groups, communities, population Individuals IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 15
- 16. Health promotion measures (A) Health promotion Factors influencing Health Health status of the Outcome levels measures (A) health determinants (B) determinants (C) population (D) Infrastructures A1: Development services of services A2: Advocacy Legal system Administration Networking Organisation Networks organisations Health Groups A3: Social Communities Population mobilisation A4: Individuals Development of individual skills IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 16
- 17. Factors influencing health determinants (B) Health promotion Factors influencing Health Health status of the Outcome levels measures (A) health determinants (B) determinants (C) population (D) Infrastructures A1: Development B1: Health services of services promoting services Legal system A2: Advocacy B2: Public policy Administration Organisation Networking and organisational Networks organisations practice Health Groups Communities A3: Social B3: Social potential Population mobilization and commitment Individuals A4: Development B4: Individual of individual skills health-related life skills IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 17
- 18. B1 Health promoting services Health promotion Factors influencing Health determinants Health status of the Outcome levels measures health determinants population Infrastructures Development of B1: Health services services promoting services Legal system Advocacy Administration Organisation Networking Networks organisations Health Groups Communities Social mobilization Population Individuals Development of individual skills IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 18
- 19. B1 Health promoting services § B1-1 Awareness of the service § B1-2 Accessibility of the service and reaching of target groups § B1-3 Use of the service and satisfaction with it § B1-4 Sustainability of the service § B1-5 Improved professionalism in health promotion – Professionals, mediators – Population IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 19
- 20. B2: Health promoting public policy and organisational practice Health promotion Factors influencing Health determinants Health status of the Outcome levels measures health determinants population Infrastructures Development of B1: Health services services promoting services Legal system Advocacy B2: Public policy Administration Organisation Networking and organisational Networks organisations practice Health Groups Communities Social mobilization Population Individuals Development of individual skills IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 20
- 21. B2 Health promoting public policy and organisational practice § B2-1 Binding engagement of decision-makers and/or key persons § B2-2 Action-relevant, binding written basis § B2-3 Successful organisational changes § B2-4 Successful exchange and cooperation – Policy – Organisations IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 21
- 22. B3 Health promoting social potential and commitment Health promotion Factors influencing Health Health status of the Outcome levels measures health determinants determinants population Infrastructures Development of B1: Health services services promoting services Legal system Advocacy B2: Public policy Administration Organisation Networking and organisational Networks organisations practice Health Groups Communities Social mobilization B3: Social potential Population and commitment Individuals Development of individual skills IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 22
- 23. B3: Health promoting social potential and commitment § B3-1 Existence of active groups focusing on health promoting concerns or themes § B3-2 Enlisting of new players § B3-3 Awareness of the concern by population groups § B3-4 Acceptance of a concern by population groups IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 23
- 24. B4 Individual health-related life skills Health promotion Factors influencing Health Health status of the Outcome levels measures health determinants determinants population Infrastructures Development of B1: Health services services promoting services Legal system Advocacy B2: Public policy Administration Organisation Networking and organisational Networks organisations practice Health Groups Communities Social mobilization B3: Social potential Population and commitment Individuals Development of B4: Individual individual skills health-related life skills IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 24
- 25. B4 Individual health-related life skills § B4-1 Factual health-relevant knowledge and capacity to act on knowledge § B4-2 Positive attitudes towards a health-relevant topic § B4-3 New personal and/or social skills § B4-4 Strengthened self-confidence regarding a health- relevant topic or an activity IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 25
- 26. Health Determinants (C) Health promotion Factors influencing Health Health status of the Outcome levels measures (A) health determinants (B) determinants (C) population (D) Infrastructures A1: Development of B1: Health services services promoting services C1: Physical environment Legal system A2: Advocacy B2: Public policy Administration Organisation Networking and organisational Networks organisations practice C2: Social environment D:Health Groups Communities A3: Social B3: Social potential Population mobilization and commitment C3: Indiv. resources/ behavioural patterns Individuals A4: Development B4: Individual of individual skills health-related life skills IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 26
- 27. C1 Health-promoting physical environment Health promotion Factors influencing Health Health status of the Outcome levels measures health determinants determinants population Infrastructures Development of Health promoting services services services C1: Physical environment Legal system Advocacy Public policy and Administration Organisation Networking organisational Networks organisations practice Health Groups Communities Social mobilization Social potential and Population commitment Individuals Development of Individual health- individual skills related life skills IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 27
- 28. C1 Health-promoting physical environment § C1-1 Reduction of pollution caused by physical-chemical influences § C1-2 Conservation and improvement of natural resources § C1-3 Health-promoting installations and products – Work place, education, school – Habitation, home – leasure, mobility IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 28
- 29. C2 Health-promoting social environment Health promotion Factors influencing Health Health status of the Outcome levels measures health determinants determinants population Infrastructures Development of Health promoting services services services C1: Physical environment Legal system Advocacy Public policy and Administration Organisation Networking organisational Networks organisations practice C2: Social environment Health Groups Communities Social mobilization Social potential and Population commitment Individuals Development of Individual health- individual skills related life skills IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 29
- 30. C2 Health-promoting social environment § C2-1 Social support, social networks, social integration § C2-2 Social climate § C2-3 Equal access to general social resources – Work place, education, school – Habitation, home – Leasure, mobility IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 30
- 31. C3: Health-promoting individual resources and behavioural patterns Health promotion Factors influencing Health Health status of the Outcome levels measures health determinants determinants population Infrastructures Development of Health promoting services services services C1: Physical environment Legal system Advocacy Public policy and Administration Organisation Networking organisational Networks organisations practice C2: Social environment Health Groups Communities Social mobilization Social potential and Population commitment C3: Indiv. resources/ behavioural patterns Individuals Development of Individual health- individual skills related life skills IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 31
- 32. C3: Health-promoting individual resources and behavioural patterns § C3-1 Health promoting individual skills § C3-2 Improved health-relevant behaviour and patterns of behavioural – Work place, education, school – Habitation, home – Leasure, mobility IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 32
- 33. D: Improvement of a population´s health and quality of life Indicators regarding: § Increased healthy life expectancy § Increased health-related quality of life § Lower morbidity § Less premature mortality IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 33
- 34. The Swiss Model for Outcome Classification in Health Promotion and Prevention (SMOC): Plan of presentation § Why and how was this model developed? § What is the purpose and context of its use? § What is its theoretical basis and structure? § How is the model applied in practice? IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 34
- 35. Elderly in the community : situation analysis Neighbourhood Health promoting construction Development of services services unfavourable to elderley C1: Physical pedestrians environment Absence of public Public policy and Advocacy Networking policy organisational Institutionalisation organisations practice Social isolation Poor Quality of Life C2: Social Health Loneliness environment Frailty Insecurity Social mobilization Social potential and Low public commitment awareness C3: Indiv. resources/ behavioural patterns Development of Individual health- Low physical individual skills related life skills Fear activity Resignation IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 35
- 36. Elderly in the community : programme theory Apartment rented as Health promoting small community centre Development of services services Project Agenda 21 for C1: Physical garden Neighbour community garden environment activities Seek Advocacy Public policy and partnerships Networking Joint organisational project with Elderly live organisations municipality: QoL practice Increased social independently C2: Social Health Residents of contact environment Increased strength ProSenectute all ages Intergenerational Less depression Social mobilization Social potential and community Residents understanding participate in commitment development design and Community group C3: Indiv. resources/ project created behavioural patterns construction Development of Individual health- Increased of garden individual skills related life skills physical activity Increased confidence IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 36
- 37. Outcome model of a prevention project on obesity in infants Development and Broad dissemination, wide use by maternal consultants Dissemination A1 B1 Development of health High attainment Health promoting services Parental satisfaction, few of target groups promoting services and many coachings Acquisition dropouts C1 Health promoting physical Tools Improved expert skills environment Further education B2 A2 Committed promoting public policy and Health Advocacy, cooperation of consultantsorganizational practice organizations C2 Networking with Health promoting social/societal pediatrics Successful cooperation environment D Improved eating culture Health B3 A3 Health promoting social potential and Family meals, slow food, eating without distraction/TV,… Social mobilization commitment C3 Health promoting individual Improved eating behavior resources and behavioural A4 B4 More fruits, vegetables and salads, less patterns sweets,snacks and sweet beverages. Increased Development of Health-related Improved life skills consumption of sugarless beverages Coachings individual skills Healthy weight educational by parent Improved educational behaviour counsellors skills Increased physical activity Increased activity outdoors, less computer and IUMSP television Measures Objectives Institut universitaire de médecine sociale et préventive, Lausanne 37
- 38. Outcome model of a prevention project on obesity in infants: How many parent counsellors research questions have Development and been reached? Broad dissemination, wide use by Dissemination A1 maternaal consultants Which parents B1 can be reached? few How good is the quality target groups services Development of health High attainment Health promoting of Parental satisfaction, promoting services and many coachings Acquisition of the training? dropouts C1 Health promoting physical Tools Do the parent counsellors Improved expert skills environment Further education have better skills due to the B2trainings? A2 Committed promoting public policy and Health Was it possible to change Advocacy, cooperation of consultantsorganizational practice organizations Is the networking with C2 eating culture of the the families? Networking with Health promoting social/societal pediatrics successful? pediatrics Successful cooperation environment D Improved eating culture Health B3 A3 Health promoting social potential and Family meals, slow food, eating without distraction/TV,… Social mobilization commitment Quality of the What is the influence on Do children eat T o what extent has C3 coaching? parental attitudes and healthier? educational behaviour eating individual Health promoting behavior Improved skills? resources and behavioural Decrease of A4 B4 changed? fruits, vegetables and salads, less More patterns sweets,snacks and sweet beverages. Increased body weight? Development of Health-related Improved life skills consumption of sugarless beverages Coachings individual skills Healthy weight educational by parent Improved educational behaviour councellors skills More physical activity More activity outdoors, less computer and Are they more IUMSP television active? sociale et préventive, Lausanne Institut universitaire de médecine 38
- 39. Stakeholder Workshop Process § Participation: § within stakeholder groups § between stakeholder groups § Communication: § implicit becomes explicit § exchange and clarify § agree on transparent objectives IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 39
- 40. Foto IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 40
- 41. IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 41
- 42. An iterative process… but nonetheless with outputs… IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 42
- 43. Overall process leading to the definition of an evaluation framework Ø Situation analysis Ø Programme theory Ø Choice of « priority » objectives Ø Definition of relevant/key indicators Ø Definition of corresponding anticipated values § quantitative § qualitative IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 43
- 44. Elderly in the community : possible indicators Apartment rented as Health promoting Maintenance of small community centre Development of services services garden C1: Physical garden Neighbour Frequency of activities Project Agenda 21 environment activities Seek Advocacy Public policy and partnerships Networking Joint organisational project with Elderly live organisations municipality practice Level of satisfaction Increased social C2: Social independently Health regarding atmosphere contact Residents of environment Increased strength ProSenectute all ages in neighbourhood Intergenerational Social potential and Less depression Social mobilization community Residents Frequency of contacts understanding participate in commitment development design and Community group Level of C3: Indiv. resources/ project created behavioural patterns construction participation Development of Individual health- Low physical of garden Level of physical individual skills related life skills activity activity Increased confidence IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 44
- 45. Individual programmes and projects do not need to provide evidence of progress from Epidemiological data C to D: Health promotion Factors influencing Health Health status of the measures (A) health determinants (B) determinants (C) population (D) Infrastructures A1: Development B1: Health services of services promoting services C1: Physical environment Legal system A2: Advocacy B2: Public policy Administration Networking and organisational Organisation Networks organisations practice C2: Social environment D:Health Groups A3: Social B3: Social potential Communities Population mobilization and commitment C3: Indiv. resources/ behavioural patterns Individuals A4: Development B4: Individual of individual health-related life IUMSP skills skills Institut universitaire de médecine sociale et préventive, Lausanne 45
- 46. IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 46
- 47. Where are we now? § Dissemination of use § National § International § Sustainability/ Integration of SMOC into: § further education and training § technical support system § quality assurance methodology (http://www.quint-essenz.ch/en.html) § grant management process § Multiple uses and levels of application § Creation of web-based community of users § Links with systems management IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 47
- 48. Key characteristics of the SMOC § Communication and understanding is promoted between stakeholders § Provides synthesis of multiple perspectives § Development of common language § Acknowledges complexity § Brings together different forms of evidence from research and expert/practitioner knowledge § Interventions are developed on a theoretical and evidence- based framework § Hypotheses regarding change theory are made explicit and can be verified: performance AND learning objectives IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 48
- 49. Thankyou for your attention! IUMSP Institut universitaire de médecine sociale et préventive, Lausanne 49