The Swiss Model for Outcome Classification in Health ...lbihpr.lbg.ac.at/de/sites/files/lbihpr/docs/LTC/Veranstaltungen... · University Institute for Social and Preventive Medicine,

IUMSPInstitut universitaire de médecine sociale et préventive, Lausanne

The Swiss Model for OutcomeClassification in Health Promotion andPrevention (SMOC)

Ludwig Boltzmann Institute, Vienna. 20th May 2009

University Institute for Social and Preventive Medicine, Lausanne:Spencer, Brenda

University Institute for Social and Preventive Medicine, Bern:Cloetta, Bernhard; Spörri-Fahrni, Adrian

Health Promotion Switzerland: Ruckstuhl, Brigitte; Broesskamp, Ursel; Ackermann, Günter


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Plan of presentation

Origins of the model

Structure of the model

Process of development and dissemination

How applied in practice


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Our ever-faithful friend, the black box

Measuresapplied:

•Projects •Programmes•Strategies•Policies

Improvementof a population‘s

health


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Mandate for SMOC

System of outcome categories with sub-categories linked to indicators

Possibility for comprehensive application

Supply a common language

Provide overview of Health Promotion Switzerland projects

Prospective and Retrospective application

Assist in clear formulation of objectives


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Theoretical and Methodological underpinnings and links

Field of Health:Ottawa Charter, 1986Don 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 Evaluationlogic 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)


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Swiss Model for Outcome Classification

D:Health

B1: Health promoting services

B2: Public policyand organisational practice

B3: Social potential and commitment

C2: Social environment

C3: Indiv. resources/ behavioural patterns

Individuals

Groups CommunitiesPopulation

Legal system Administration Organisation Networks

Infrastructures services A1: Development

of services

A2: Advocacy Networking organisations

A3: Social mobilization

A4: Developmentof individual skills

Health promotion measures (A)

Health determinants (C)

Health status of the population (D)

Factors influencing health determinants (B)

B4: Individual health-related life skills

C1: Physical environment


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SMOC: Levels of outcome and focal points

Health

Health promotion measures

Factors influencing health determinants

Health determinants

Individuals

Groups, communities, population

Legal system, administration, organisations

Infrastructures, services

Health status of the population


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Health




Individuals



Infrastructures services

A1: Developmentof services


A3: Social mobilisation

A4: Development of individual skills

Health status of the population (D)Outcome levels


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Health





Individuals




of services









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B1 Health promoting services

Health



Health determinants


Health status of the populationOutcome levels

Individuals



Infrastructures services Development of

services

Advocacy Networking

organisations

Social mobilization

Development of individual skills


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B1 Health promoting services

B1-1 Awareness of the service B1-2 Accessibility of the service and reaching of target

groupsB1-3 Use of the service and satisfaction with itB1-4 Sustainability of the serviceB1-5 Improved professionalism in health promotion

– Professionals, mediators– Population

B1-4: „The exercise programme is integrated into an existing organisation or institution.“


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B2: Health promoting public policy and organisational practice

Health


Health determinants




Individuals



Infrastructures services


Development of services

Advocacy Networking

organisations

Social mobilization



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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

B2-2: „The local council approved the plan proposing measures for the promotion of quality of life in the community .“

B2 Health promoting public policy and organisational practice


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B3 Health promoting social potential and commitment

Health


Health determinants





Individuals




services

Advocacy Networking

organisations

Social mobilization




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B3-1 Existence of active groups focusing on health promoting concerns or themes

B3-2 Enlisting of new playersB3-3 Awareness of the concern by population groupsB3-4 Acceptance of a concern by population groups

B3-1: „The parent initiative for Safe Ways to School holds its inaugural session.“

B3: Health promoting social potential and commitment


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B4 Individual health-related life skills

Health





Individuals




services

Advocacy Networking

organisations

Social mobilization

Development ofindividual skills


Health determinants




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B4 Individual health-related lifeskills

B4-1 Factual health-relevant knowledge and capacity toact on knowledge

B4-2 Positive attitudes towards a health-relevant topicB4-3 New personal and/or social skillsB4-4 Strengthened self-confidence regarding a health-

relevant topic or an activity

B4-1: „City residents know which of the social factors intheir neighbourhood has animpact on their health.“


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Health Determinants (C)

D:Health





C3: Indiv. resources/behavioural patterns

Individuals


Legal system Administration OrganisationNetworks

Infrastructures services A1: Development of

services








B4: Individual health-related lifeskills



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C1 Health-promoting physical environment

Health

Health promoting services

Public policy andorganisational

practice

Social potential andcommitment

Individual health-related life skills


Individuals




services

Advocacy Networking

organisations

Social mobilization



Health determinants




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C1-1 Reduction of pollution caused by physical-chemical influences

C1-2 Conservation and improvement of natural resourcesC1-3 Health-promoting installations and products

– Work place, education, school– Habitation, home– leasure, mobility

C1-2: „The grassland area within the urbanagglomeration was preservedand did not fall victim to aplanned building project.“

C1 Health-promoting physical environment


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C2 Health-promoting social environment

Health



practice



Individuals




services

Advocacy Networking

organisations

Social mobilization



Health determinants






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C2 Health-promoting social environment

C2-1 Social support, social networks, social integrationC2-2 Social climateC2-3 Equal access to general social resources

C2-3: „Social and economic policy takes account of the needsof single-parent families“

– Work place, education, school– Habitation, home– Leasure, mobility


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C3: Health-promoting individual resources and behavioural patterns

Health



practice



C3: Indiv. resources/behavioural patterns

Individuals




services

Advocacy Networking

organisations

Social mobilization



Health determinants






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C3-1 Health promoting individual skillsC3-2 Improved health-relevant behaviour and

patterns of behavioural

C3-1: „An increase in the use of sun protection is observed in the general poluation .“

C3: Health-promoting individual resources and behavioural patterns

– Work place, education, school– Habitation, home– Leasure, mobility


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D: Improvement of a population´s health

To have a good quality of life!

Increased healthy lifeexpectancyIncreased quality of life interms of healthLower morbidity Less premature mortality

Indicators regarding:


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Swiss Model for Outcome Classification

D:Health





C3: Indiv. resources/ behavioural patterns

Individuals




of services






Health status of the population (D)





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Calendar of SMOC Development Process

MODEL CONSTRUCTION FEASABILITY TESTING DISSEMINATION

Focus Evaluation + Planning + Situation analysis

Level Projects + Programmes + Cantonal/national strategy development

Activity Categorisation of outcomes

Drafting of guide to use

Construction of effects models

Development of stakeholder workshop concept

Integration in: 1 Further education/ training 2 Technical support system 3 QA system 4 Grant management process

Project initiation Sept 2002

First version

July 2004

Second version

July 2005


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Three types of applicationSituation analysis

Where is a specific problem to be located?How may the problem have arisen? To which categories can the factors

contributing to the development of theproblem be attributed and how do they relate

to each other? Are there other players that

may already be having an impact?

Intervention planning

How can the health of thepopulation be maintained or how can a health-

related problem be reduced?

In which categories should the project’s objectives be situated and how do the objectives interact?

EvaluationWhich factors have

contributed in which way to maintain health orreduce health-related problems in the

population?

In which categories have resultsbeen achieved and how do these results

interact?


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"Looks like the research boys really came upwith something this time."

How is the SMOC applied in practice…………….?


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Foto


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Workshop Process

Multi-stakeholder participation

Definition: Implicit – explicit – confront – values clarification - agreement on transparent objectives

Definition - Feedback – Validation Situation analysisProgramme theory (effects model)PrioritiesIndicators (anticipated values)


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C3Ressources

personnelles et types de

comportement favorables à la

santé

DSanté

Activités de promotion de la santé

Facteurs qui influencent les déterminants de la santé

B1Offres en matière de promotion de la santé

C2Environnement

social favorable àla santé

Bénéfice pour la

santé de la populationA1

Développement d’offres de

promotion de la santé

A2Représentation

d'intérêts,collaboration

entre organisations

A3Mobilisation

sociale

Déterminants de la santé

B2 Stratégies de promotion de la santé dans la politique et

les institutions

B3Potentiel social et engagement favorables à la santé

B4Compétences individuelles favorables à la santé

C1Environnement

physique favorable à la

santé

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uctu

res

et p

rest

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gisl

atio

ns,

orga

nisa

tions

, ré

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tionn

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Gro

upes

, co

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A4Développementde compétences

personnelles

Manque de structures d’accueil accessibles et attirantes pour personnes agées

B2.4 Mise au point d’un partenariat avec les écoles

B3.2 Les écoliers participent au programme intergénérationnel pour la livraison des paniers de commissions aux personnes en voie d‘isolement

Personnes âgées vivant seules

Absence de proches

Manque de confiance

Dépression

Carences dues à une mauvaise nutrition

Peu de contactes avec voisinage

Politique urbaine inadaptée

B1.2 Les personnes âgées en voie d’isolement participent aux repas

A2 Recherche de collaborations auprès des établissements scolaires

A3 Promotion du concept intergénérationnel

B1.1 Les personnes âgées en voie d’isolement connaissent l’existence et les modalités de l’offre

A1 Animation des repas communautaires

C2.3 Programme de livraison mise en œuvre et perennisé

D Les personnes en voie d’isolement restent en bonne santé grâce à une nutrition adéquate

D Le processus d’isolement chez

les personnes vulnérables est

freiné

C2.1 Les personnes vulnérables sont mieux entourées

Commerces de proximité inadaptés


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Continued dissemination of SMOCGesundheitsförderung Schweiz website: « Ergebnismodell »http://www.gesundheitsfoerderung.ch/pages/Gesundheitsfoerderung_und_Praevention/Tipps_Tools/ergebnismodell.php?lang=d

Health Promotion International: Spencer et al. 23 (1): 86. (2008)http://heapro.oxfordjournals.org/cgi/content/full/dam038?ijkey=zQDCckIz8KuMxob&keytype=ref

Examples of SMOC applicationsPublication Series « Raisons de santé » www.iumsp.chNo 130 Dubois-Arber F., Spencer B. Développement d’indicateurs pour le contrat de prestations 2008 entre le Cipret et le département de l'économie et de la santé (DES). Lausanne 2007 (pdf 362 Kb)No 129 Spencer B., Dubois-Arber F. Développement d'indicateurs pour le contrat de prestations 2008 entre la FEGPA et le département de l'économie et de la santé (DES). Lausanne 2007 (pdf 647 Kb)


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Merci vielmals für Ihre Aufmerksamkeit!

Ihre Fragen?Vos questions?Any questions?

The Swiss Model for Outcome Classification in Health ...lbihpr.lbg.ac.at/de/sites/files/lbihpr/docs/LTC/Veranstaltungen... · University Institute for Social and Preventive Medicine,

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