Another paper on the W3 Project has just been published, providing an overview of the W3 Framework and highlighting the critical role of peer leadership in the response to HIV and Hepatitis C
Open Access full article is available at : https://doi.org/10.3389/fpubh.2018.00231
Brown, G., Reeders, D., Cogle, A., Madden, A., Kim, J., & O’Donnell, D. (2018). A Systems Thinking Approach to Understanding and Demonstrating the Role of Peer-Led Programs and Leadership in the Response to HIV and Hepatitis C: Findings from the W3 Project. Frontiers in Public Health, 6(231). doi:10.3389/fpubh.2018.00231
The central role of community and peer-led programs has been a key characteristic of the Australian partnership response to HIV and hepatitis C since the beginning of the epidemics. Despite this, peer-led programs continue to have limited capacity to demonstrate their role and value as part of a multi-sectoral response. What makes one peer-led program a better investment than another? What role does the rest of the sector have in ensuring we gain the most value from these investments?
To investigate this, we facilitated interactive systems thinking methods with 10 programs working within communities of people who inject drugs, gay men, sex workers and people living with HIV across Australia. This included articulating program theories in diagram and textual form to help us understand the role of peer-based programs promoting peer leadership within the Australian HIV and hepatitis C responses. Our aim was to develop a framework for monitoring and evaluation that could be applied to peer led programs at different levels and in different contexts.
We found that for peer-led programs to fulfill their role, and to navigate the rapid changes occurring in the both epidemics, they need to: demonstrate the credibility of their peer and community insights; continually adapt to changing contexts and policy priorities in tandem with their communities; and maintain influence in both community and policy systems. We developed a framework of four key functions (Engagement, Alignment, Adaptation, and Influence) which peer-based programs need to demonstrate, which form the basis for identifying quality indicators. This article presents a new way of framing and monitoring investments in peer-led programs and peer leadership actions by these programs.
If health policy is committed to strengthening the leadership shown by affected communities, then we need to understand, enhance, monitor and value the role of peer-led programs and peer leadership within the overall prevention system. We believe the W3 framework, drawing on systems thinking and modeling, can support funders, policy-makers and programs to achieve this.
The Australian Federation of AIDS Organisations has drawn on the W3 Project and practitioner experience to develop a tailored theory of change showing how AFAO and Australia’s State and Territory AIDS Councils’ distinct approach to health promotion leads to efficient and effective programs, making an important contribution to Australia’s HIV response.
“ The Theory of Change highlights the functions of engagement, alignment and adaptation, and shows how AFAO and AIDS Councils fulfill these functions, increasing their influence. While a diagram cannot fully capture the complexity of social change, it is useful for establishing a shared understanding of how change occurs and for identifying early indicators of success.”
You can down load the AFAO and AIDS Council Theory of Change from AFAO’s website here
Eight case studies from across Australia
AFAO and its members have also developed a series of eight case studies to demonstrate the theory of change working in practice.
You can down load the case studies here
This theory of change was developed Alison Barclay Consulting on behalf of Australian Federation of AIDS Organisations. Concepts were drawn from Brown and Reeders (2016) What Works and Why – Stage 1 Summary Report with support from the W3 Project.
Links as text
Guest Blogpost by Timothy Krulic, Health Promotion Officer at Living Positive Victoria.
As the peer researcher of Stage 2 of the W3 Project at Living Positive Victoria I’ve been able to see firsthand what we’ve been learning as an organisation and the benefits and changes we’ve been making to how we do peer research and program evaluation.
Our first step was to run a series of seminars to upskill and educate the staff and volunteers involved in running Living Positive Victoria’s peer education and support programs. These seminars introduced systems thinking and the principals and practices behind W3. Through an iterative process we then worked with staff to develop program narratives and timelines to describe how their programs work from start to finish to produce outcomes for individuals and communities within their given environments.
What we found was that through articulating program narratives staff were able to identify a number of key indicators that provide insight into how engagement, alignment, learning and adaptation and influence were functioning in their programs. These linear program narratives also enabled us to identify points for data collection which had the least impact on program operations and the time of staff.
New tools and methods for data collection and program monitoring have been trialled and adapted over the last six months and are now in use for the Phoenix workshops for women and gay and bisexual men newly diagnosed with HIV, the HIV and Ageing Project for chronic health self-management and peer networking, and the Positive Leadership Development Institute (PLDI) Australia and New Zealand workshops. We are now better able to understand and track the influence and engagement of programs in the networks of participants by using new tools to capture the community profile of workshops, while much of the feedback we gather is collected by workshop facilitators and staff completed forms.
These tools enable reflective practice, gather critical information on how programs align, adapt, engage and influence, as well as streamline evaluation processes. This has lessened the burden of data collection on peer workers and participants and allowed us to capture more detailed data on changes in resilience, quality of life, social connection and leadership practice measures, which are now collected through participant feedback forms instead. We are currently in the process of developing similar tools to evaluate and monitor one-on-one peer support and navigation, and group peer support activities and social events, such as our family days and adult retreats, the Cook n’ Chat nights for heterosexual men and the Gen Next group for youth and young people living with HIV.
The next step is to communicate our learnings throughout the organisation in our second-year seminars, however, we are already seeing greater confidence and capacity among peer workers to conduct peer research and program evaluation. Building the capacity of peers in this way is a key strategic aim for Living Positive Victoria, empowering people living with HIV to be meaningfully involved in our work and supporting a two-way flow of influence between our community and the organisation.
The W3 Project is really excited to be working with Living Positive Victoria on their new expanded Peer Navigator project.
Health Minister Jill Hennessy made the announcement at the launch of World AIDS Day held at the Doherty Institute on Friday morning. The pilot project will run for 3 years (2018-20) and be led by Living Positive Victoria.
Interim CEO of Living Positive Victoria, Suzy Malhotra, said that harnessing the lived experience of people living with HIV (PLHIV) is significant and should be at the forefront of the HIV response.
Christabel Millar, President of Living Positive Victoria, agrees that this pilot project will make a difference for people at a crucial time in their HIV journey.
“Each person is different but the shared similarities of PLHIV allows individuals to connect on a unique and intimate level that cannot be replicated through other support services,” said Millar.
Graham Brown from the W3 Project added
There is great opportunity for this project to not only provide timely support to people with HIV at key points in their journey, but also gain real time insights into the barriers and enablers for PLHIV. This will be crucial as we strive to end stigma and create a more effective response to HIV. This has great potential to help the whole HIV response reorient and adapt.
W3 Project will be supporting Living Positive Victoria to monitor and enhance the effectiveness of the program to contribute to engagement with PLHIV, alignment across the sector, adapt to evolving experiences of PLHIV, and have stronger influence in the PLHIV community and in policy.
Guest Blog by Randelle Anderson, Senior Communications Officer at Living Positive Victoria
Adopting the W3 framework for Living Positive Victoria’s annual report went beyond highlighting the organisation’s activities over the last financial year. The framework helped to show the effectiveness of each activity, event, workshop and relationship, and how that impacted the organisation’s vision to better the health and wellbeing of people living with HIV (PLHIV).
The report’s themes were adapted from the W3 framework to give the annual report a strong narrative that was broken into four sections. This bridged the operational and business work of the organisation and made the report more engaging for readers and more appealing to a broader audience.
|W3 Themes||Living Positive Victoria’s Annual Report Themes|
|Engagement||Connecting and Engagement|
|Learning and Adaptation||Learning and Adapting|
|Influence (Community)||Strengthening the Community|
Each theme was defined at the start of each section which made the information much easier to follow and understand.
Connecting and Engagement – Relational living – feeling connected to your community – is vital for people living with HIV (PLHIV). Each individual has their own background, journey and story that we get to be a part of.
Learning and Adapting – Life never stops teaching. By continuously learning we are able to do things we were never able to do and find ways to address the evolving nature of HIV.
Strengthening the Community – The voice of people living with HIV (PLHIV) must be at the forefront of the HIV response. We continue to invest in our community to build up the resilience of PLHIV and position them as champions, role models and leaders.
Stronger Together – Real transformation will only happen when we embrace diversity, embrace our differences and contend for the same thing: the rights and wellbeing of people living with HIV (PLHIV).
The content was organised based on how it demonstrated the idea/concept for each theme. We looked at the impact and result of each activity and used facts, figures and testimonials to strengthen the information.
Weaved through the entire report was the relationships the organisation has with its stakeholders. The W3 framework helped the report focus on the diversity of those relationships and how those relationships continue to evolve and bring about real change in the HIV response.
As a public document, the annual report is accessible by all stakeholders to review which keeps the feedback loop open and the organisation can use any feedback to adapt the report in the future.
Through our W3 Project and HIV Futures study collaborations with PLHIV peer organisations, it became apparent that HIV peer, community, and healthcare services in Australia needed an empirically validated, short and practical way to measure quality of life of PLHIV to evaluate the impact of their programs.
The PozQoL study aimed to develop, test and validate such as scale to be easily incorporated into the day-to-day practice of peer, community, and health services.
The study was embedded in the principles of the greater and meaningful involvement of people with HIV, with peer led PLHIV organisations working in partnership at every step – from concept and implementation through to analysis and use.
The full details about PozQoL can be downloaded at here.
We have also developed an interim instructions summary which can be downloaded here
The short scale is available for use and is currently being piloted in a number of peer and community based organsations.
We will be conducting a full implementation trial across community, peer and health organisations in 2018. For more details and to express interest in participating contact email@example.com
PozQoL is a partnership project of the Australian Research Centre in Sex,
Health and Society (ARCSHS), ViiV Healthcare, National Association
of People with HIV Australia (NAPWHA) with Living Positive Victoria,
Positive Life NSW, and Queensland Positive People
Our work with Living Positive Victoria and Harm Reduction Victoria has been progressing with a range of tools and approaches being trialled to enhance the evaluation of Engagement, Alignment, Adaptation, and Influence (W3 Framework functions) as well as Peer Skill.
Below are just four examples from across the work we are doing
Our collaboration with Harm Reduction Victoria includes their Peer Networker Program (PnP). The PnP recruits, trains and supports ‘peer networkers’ to distribute needles and syringes to their friends and associates as well as providing education about safer drug use and ‘modelling’ safer injecting practices.
- To enhance our understanding of engagement through the PnP, we have been revising the data sheets and analysing the geographic and gender diversity of who the program reaches compared to other needle and syringe programs.
Influence – Policy
- To strengthen the voice of people who use drugs and enhance the advice to the rest of the sector, we have been trialling the collection of current peer insights and feedback from the different networks in the PnP.
Adaptation and Peer Skill
- The Phoenix workshops result in rich peer discussion and problem solving. After the workshop – the peer facilitator’s debrief is a key moment with reflexive discussions– particularly about emerging issues and the quality of the peer experience occurring in the workshop. However, these insights were not being well captured for sharing within or beyond the program. Therefore we have been developing a brief facilitator feedback tool that can tap into and capture the expertise and experience of peer facilitators while minimising number of process feedback questions for participants.
Influence – Community
- To enhance our understanding of the impact of peer led programs for PLHIV, we have collaborated with a range of PLHIV peer organisations (including Living Positive Victoria) and ViiV Healthcare to develop, trial and validate the PozQoL scale. See the separate post on PozQoL or download the summary here
We are also working with both organisations to develop clearer overall indicators for the peer led programs drawing on the W3 Framework.
In coming months we will be uploading the developed tools and approaches. For more information in the interim, contact firstname.lastname@example.org