A proposal of framework to evaluate community-based obesity prevention interventions in LAC
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A proposal of framework to evaluate community-based obesity
prevention interventions in LAC
Marcia Erazo, Margarita Safdie, Mariana Lazo, Angel Caballero, Richard Visser, Armando Barriguete
PACO IIIWorkshop: EPODE Population based interventions
Background
• In Latin America and the Caribbean (LAC) the obesity prevalence has raised at alarmingly pace.
• Community-based interventions are the most promising interventions because they can reach the entire population.
• These interventions are recommended to address the obesity causes rooted in the society and special needs of the individuals.
Background
• Ideal community interventions combines specific health promotion and evaluation theory.
• In LAC, there is no community interventions probably due to lack of evaluation frameworks.
• Limited data are available to guide the implementation and evaluation of these interventions in LAC.
Rationale
• Standardized and comprehensive evaluation frameworks are key for policy-makers, scientists and stakeholders to evaluate community-based programs
Objective
To thoroughly examine already available evaluation frameworks (WHO, EPODE, and Victoria proposals) and related literature, and to provide a specific framework to evaluate community-based interventions in LAC.
Policy Makers
Practitioners
PublicOther Stakeholders
External Groups
Key stakeholders
WHO Steps Evaluation Health promotion programs
1. Describing the proposed program, policy or initiative1. Program logic2. Identify group to undertake the evaluation3. Baseline data
2. Identify key issues and concerns1. Key outcomes indicators2. Stakeholders interests
3. Design: study, data collection4. Data collection as planned5. Data analysis6. Recommendations7. Dissemination of results8. Take action
Page 55 (28)-56(29)
Wimbush and Watson. Evaluation framework for health promotion
• Common themes in evaluation (Policy and strategic planning)– Outcomes and effectiveness
• Other important components (other stakeholders):– Improvement in quality of program– Improvement in program design
Health Education Board Scotland
Tip of Iceberg
Wimbush and Watson. Evaluation framework for health promotion
• Perspectives:– Policy Makers and Strategic Planners: (make decisions and are held
accountable)• What works?• What are the best buys?
– Program Managers: (role: budget holders, responsible for the delivery)• Success, based on achievement of goals, extent of reacheness and
sustainability– Practicioners: (role: operation and running of programs)
• Feedback from people involved in the collaborative action– Community/Users:
• Avenue to provide feedback, involvement: express concerns, satisfaction• Extent to which program meets their perceived needs
Wimbush and Watson. Evaluation framework for health promotion
• Stages Evaluation– Planning– Design and Pilot– Implementation –early start up– Implementation –establishment– Implementation –fully operational – Dissemination
Evaluation Framework for Health Promotion and Disease Prevention Programs. Victoria, Australia
• Describe the program– Program logic
• Evaluation preview:– Process– Outcomes– Implications for Future programs and policy
• Focus evaluation design:– Agreed or common indicators
• Collect Data• Analyse and Interpret Data• Dissemination of the results
EPODE
• By level:– Central– Local– Settings– Child
• To date, all EPODE programs have initiated continuousmonitoring and evaluation practices at central, local andchild levels, as well as in certain settings such as schools.• Developing consistent practices and collecting comparable data
across communities and programs remains an important challenge.
Obesity Rev 2011
Proposal of a framework to evaluate community-based interventions to prevent child obesity LAC
Public Policy
Policy design Policy process
Conceptual frameworkLogic model
Objectives to achieve
Political concernFocused on the electorate
Objectives not declared
Effectiveness Rating
HIGH QUALITYCitizen’s feelings and technically correct
Good governance
Open: Active communication, accessible language, trust between citizens and the institutions.
Participation: Wide community participation during development,Implementation and evaluation stages to achieve a public policy with high quality, pertinence, efficacy.
Efficacy: Actions must achieve results as planned, evaluating their future impact on the community and considering cumulative experience.
Coherence: Policies and actions must be coherent and easy to understand.
We need to evaluate both, Policy design and its effectiveness and Policy Process
Policy design and its effectiveness Policy process
Through rigorous scientificmethods
Through key questionsThat reflect the politicalEnvironment and supportAnd Population satisfaction
Why to evaluate political process?
Politically strategic and democratic: Responsibility and accountability (social, economic and technical).
Managerial: It helps to improve public management and the quality of the program
Transparence: Strong mechanism to create “public value”. Society needs to know the way the money is spent, the results and the impact of the policies.
Participation: It strengthens the communities and individuals. It also improves control and efficiency of public administration.
Public Policy
Plans
Programs
Projects/Interventions Public services
Complexity
+++
+
Political:Decisions
Agreements
Actions
Problem definitionStakeholders
ObjetivesLogic model
NationwideMonitoring and
Surveillance
Investigation
Policy designWHO Ireland Australia CDC EPODE
Describe proposed program
Common themes in evaluation
Describe program Engage stakeholders Multilevel
Identify key issues and concerns
Engage other stakeholders
Evaluation preview Describe program Multi
stakeholders
Design study and data collection
Consider different perspectives
Evaluation design Evaluation design
Continuos monitoring and
evaluation
Collect dataConsider different
stages of evaluation
Collect data Gather credible evidence
Collecting comparable data
accroos the levels, settings
Data analysis Analyse data Justify conclusions Use logic model
Recomendations DisseminationEnsure use and share lessons
learnedDisemination
Take action
Key common issues
Proposal of a Comprehensive framework LAC
Planning Implementing Results Impact
Need / Problem
Intervention
Objectives Actions Intermediate results Final results Health impact
Diagnose and designEvaluation
ImplementationEvaluation
Results evaluation Impact evaluation
Ex Ante Intermedia Ex post
Beneficiaries/Society
Normativeexistance
Stakeholders ParticipationPolitical commitment
Population feelingCommunity believes
Ex Ante Intermedia Ex post
• To analyse and determine if the intervention is adequate to solve the problem
• It pretends to guarantee that the intervention will achieve the goals
It must evaluate:
• Needs• Program theory• Coverage• Potencial effects, results
and impact
• It is a critical analysis about the implementation and early results.
• It analyses the intervention validity, the pertinence of the objectives, the quality of the managerial and monitoring system.
• It encourages to
improve the implementation in order to achieve the goals
It evaluates:
• The successful of the strategy.
• Its flexibility and its capability to adapt the actions according to reality.
• Its efficacy and efficiency
• Managerial mechanisms
1. “The circumstances external to the implementing agency do not impose crippling constraints” 2.“That adequate time and sufficient resources are made available to the programme”3. That the required combination of resources is actually available”4.”That the policy to be implemented is based upon a valid theory of cause and effect” 5.“That the relationship between cause and effect is direct and that there are few if any, intervening links” 6.“That dependency relationships are minimal” 7.“That there is understanding of, and agreement on, objectives” 8.“That tasks are fully specified in correct sequence”9.“That there is perfect communication and coordination”
10.“That those in authority can demand and obtain perfect compliance”
Key questions
Thank you!!
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