A video walk-through of the W3 Framework for Learning & Evaluation

The framework shows the four key functions that need to be happening for any peer based program to be effective and sustainable in a continually changing community and political environment.

W3 at the Australasian HIV/AIDS Conference 2015

Dr Graham Brown and Natalie Hendry are representing the W3 project at the Australasian HIV/AIDS Conference 2015 in Brisbane.  We have three posters — one for each of our partner case studies — which you can view here online.

Publication: lessons from the Australian health-promotion response to HIV

Brown, G., O’Donnell, D., Crooks, L., & Lake, R. (2014).Mobilisation, politics, investment and constant adaptation: lessons from the Australian health-promotion response to HIV. Health Promotion Journal of Australia, 25(1), 35-41. dx.doi.org/10.1071/HE13078
Pre-publication version here.

Issue addressed: The Australian response to HIV oversaw one of the most rapid and sustained changes in community behaviour in Australia’s health-promotion history. The combined action of communities of gay men, sex workers, people who inject drugs, people living with HIV and clinicians working in partnership with government, public health and research has been recognised for many years as highly successful in minimising the HIV epidemic.

Methods: This article will show how the Australian HIV partnership response moved from a crisis response to a constant and continuously adapting response, with challenges in sustaining the partnership. Drawing on key themes, lessons for broader health promotion are identified.

Results: The Australian HIV response has shown that a partnership that is engaged, politically active, adaptive and resourced to work across multiple social, structural, behavioural and health-service levels can reduce the transmission and impact of HIV.

Conclusions: The experience of the response to HIV, including its successes and failures, has lessons applicable across health promotion. This includes the need to harness community mobilisation and action; sustain participation, investment and leadership across the partnership; commit to social, political and structural approaches; and build and use evidence from multiple sources to continuously adapt and evolve.

So what?: The Australian HIV response was one of the first health issues to have the Ottawa Charter embedded from the beginning, and has many lessons to offer broader health promotion and common challenges. As a profession and a movement, health promotion needs to engage with the interactions and synergies across the promotion of health, learn from our evidence, and resist the siloing of our responses.

Forthcoming workshop (Thurs 12 March)

Using a systems approach in research with peer and community based health promotion: insights, challenges and lessons learned from the W3 project

Thursday 12th March, 2015 at 9.30am-12.30pm
VicHealth Seminar Room, Ground Floor, 15-31 Pelham Street Carlton Victoria

The What Works and Why (W3) project at ARCSHS and the Centre of Excellence in Implementation and Prevention Science (CEIPS) are holding an interactive workshop on Thursday 12 March 2015. The W3 project seeks to help researchers and policy-makers understand the ‘system logic’ of peer and community-based approaches to HIV and hepatitis C. In particular, we are interested in the way flows of knowledge within health promotion programs enable them to adapt to the diversity and dynamism of their target communities, understood as complex adaptive systems. We facilitated workshops with program staff and managers using systems thinking tools and concepts, and through an iterative process, developed program theories for peer based approaches working at different levels – from direct service provision up to policy advocacy.

At this workshop, W3 and CEIPS will share and invite discussion of the insights, challenges and lessons learned along the way – both about implementing the systems approach and engaging with communities as systems in health promotion.

Places are limited, so please RSVP to Courtney Yam (courtneyyam@ceips.org.au) by Tues 10^th March COB.

End of year one wrap post

The first year of the W3 project has been incredibly busy, challenging and yet also fulfilling.

Here are some of the things we got done in 2014:

• Workshops with practitioners in four different programs — two state and two federal; one service delivery, one health promotion, and two leadership and advocacy; with people who use drugs, sex workers, gay men and people living with HIV; to articulate ‘theories in use’ by practitioners about how their programs actually work.
• Cross-sectional workshops with practitioners from a range of sectors — two national and one international — to help us identify common challenges faced by programs and organisations no matter what sector or level they work at.
• Program theories expressed in diagram and textual formats that describe how peer based programs engage with and influence the complex social and policy/funding systems in which they are located.
• Lists of what items or relationships in those diagrams practitioners thought it would be most important to monitor, both to check our understanding of the maps is correct and to assess how the program could be improved.
• A draft framework of indicators and domains that our partner organisations could use to generate, organise and package up shareable knowledge about their effectiveness against those priorities and common challenges we identified (to be distributed to partners for feedback and refinement in January).

Here’s what to expect in 2015:

• An online survey of partner organisations to get a sense of what formal and informal monitoring, evaluation and learning practices are used to generate knowledge about programs and the community and policy systems they engage with.
• A conversation with W3 partner organisations about the draft indicator framework to refine and get a sense of what looks most useful and worth testing in 2015.
• We’ll be reporting back to our funders, the Commonwealth Department of Health, at the end of January about our progress so far.  We’re hoping to include preliminary survey results and some or all of the draft indicators to provide examples of insights from the project.
• We’ll be asking our partners to try a couple of draft indicators from each of 3-4 domains — covering those high-level common challenges discussed in the workshops like engagement, influence, learning and adaptation, and integration — and to give us feedback on whether the exercise as a whole helped or hindered them in meeting those challenges.

In late 2014 we reported on our first-year findings at an ARCSHS Seminar and then sought feedback from our colleagues Alan Shiell and Lyndal Bond at CEIPS, who have a heap of experience using a systems approach in different fields.  They suggested it would be really useful to meet and run through our workshop approach with funders and policy-makers — to get a sense of how they understand the systems they’re engaged with, as well as what kind of knowledge our partner organisations could generate that would help them justify the investment in a peer and community-based approach.

To date our approach has been very much ‘from the ground up’, so seeking an additional ‘top down’ perspective could help us develop indicators that ‘meet in the middle’ — helping to translate knowledge from a practitioner and organisational perspective into forms that are shareable and productive in a policy and funding systemic context.

Wishing you a peaceful break and a productive beginning to 2015,
The W3 Project Team (at different times, Graham, Daniel, Natalie, Marina and Kylie)

Not just individuals and information: articulating the role and value of peer-based programs in HIV and hepatitis C prevention

Australian Research Centre in Sex, Health and Society Seminar Series
Wednesday 26 November 2014, 2-3pm, Room 102-103, La Trobe University, 215 Franklin Street, Melbourne, 3000

Presenters

Dr Graham Brown, Senior Research Fellow, Australian Research Centre in Sex, Health & Society, La Trobe University
Daniel Reeders, Research officer, Australian Research Centre in Sex, Health & Society, La Trobe University

Abstract

The What Works & Why (W3) project draws on practice based understandings of how peer based programs engage at the network, community, and structural levels – understandings that are often more sophisticated than much of the published evidence, which tends to focus on individuals and information.[i] We developed and tested an approach based on systems thinking[ii] that uses workshops to elicit and diagram program theories[iii] for different peer based approaches with gay men, sex workers, people who use drugs, and people living with HIV. The approach is based on the insight that communities and policy environments can be understood as complex adaptive systems.[iv] Building on realist evaluation[v], we have developed ‘system logic’ diagrams showing how interventions are embedded in and engage with communities-as-systems.

Evaluation results show participants valued the workshops and the systems approach resonated with them. Early findings have identified aspects of peer approaches that are not well described in the literature, such as the mediating role of ‘peer skill’, the collective perspective in ‘peer leadership’, and the structural and strategic value of peer based programs as sources of real-time knowledge. This presentation will discuss the findings to date from the W3 project, our reflections on using a systems approach, and the next stage of the project, developing quality indicators for the broader role of peer based approaches across the national HIV and HCV responses.

Biographies

Dr Graham Brown is the Project Lead for the W3 project. He is Senior Research Fellow at ARCSHS. His research interests include the role of peer based programs in public health responses and builds on his previous roles with the West Australian Centre for Health Promotion Research and the Australian Federation of AIDS Organisations.

Daniel Reeders (BA, LLB [Melb] Grad Dip Pub Hlth [Flin]) is the W3 project worker at ARCSHS. Previously he has worked as a senior practitioner in social marketing and community-based research at the Cancer Council Victoria, Centre for Culture, Ethnicity and Health, and Living Positive Victoria.

Contact details (RSVP is not required)
Tel: (03) 9479 8700
Email: arcshs@latrobe.edu.au
Web: www.latrobe.edu.au/arcshs

References

[i] Brown, Johnston, Ellard & Carman (2013) Evidence Synthesis and Application for Policy and Practice – Full Report. Monograph Series No. 89. Melbourne: Australian Research Centre in Sex, Health and Society.
[ii] See e.g. Meadows (2008) Thinking in Systems. White River Junction: Chelsea Green Publishing.
[iii] Weiss (1997) “Theory-based evaluation: Past, present and future” in New Directions for Evaluation 76 (Winter) p41-55; Chen (2004) Practical Program Evaluation: Assessing and Improving Planning, Implementation, and Effectiveness. London: SAGE Publications.
[iv] Holland (1995) Hidden Order. How Adaptation Builds Complexity. Reading: Addison-Wesley; Ostrom (1999) “Coping with Tragedies of the Commons” in Ann Rev Polit Sci 1999 (2) 493-535.
[v] Pawson & Tilley (1997) Realistic Evaluation. London: SAGE Publications.