We are excited to announce that due to the outcomes of W3 Stage 1(2014-2016), the Commonwealth Department of Health has funded W3 Stage 2 (2016-2019).
Full reports and resources from Stage 1 will soon be uploaded to a revamped W3 website. However, in the interim – here is a summary of what we have achieved so far
The Australian HIV and hepatitis C response is undergoing the most rapid change in decades. Community and peer-led programs needed a better way to demonstrate their unique role and contribution to achieving the goals of the National strategies, their capacity to adapt with the rapid changes, and the role of the HIV and hepatitis C partnership in supporting this role.
Working in collaboration with ten peer-led community organisations, the What Works and Why (W3) Project used systems thinking and participatory methods to develop a better understanding of how peer-based programs work, formulated a framework to evaluate the role and contribution of peer-based programs, and developed quality and impact indicators and tools to best capture and share insights from practice. This involved a series of 18 workshops ranging from one to two days each with the ten peer-led community organisations working with gay men, people who use drugs, sex workers and people living with HIV. Some workshops were with single organisations and some with up to four organisations, and over 90 people were involved across the workshops.
We found that peer-led programs are operating within and between two interrelated and constantly changing sub-systems – the community system and the policy (or sector) system. We found there are four functions that are required for peer-led programs to be effective and sustainable in such a constantly changing environment:
- Engagement: How the program maintains up to date mental models of the diversity and dynamism of needs, experiences and identities in its target communities
- Alignment: How the program picks up signals about what’s happening in its policy / sector environment and uses them to better understand how it works and to achieve better synergies
- Adaptation: How the program changes its approach based on mental models that are refined according to new insights from engagement and alignment
- Influence: how the program uses existing social and political processes to influence and achieve improved outcomes in both the community and the policy/sector.
The combination of these functions is required for peer based programs to: demonstrate the credibility of their peer and community insights; influence community, health, and political systems; and adapt to changing contexts and policy priorities in tandem with their communities.
Feasibility Trial of Indicators and Tools
We worked with nine of the W3 project partners to develop tailored indicators under each of the four functions, and then piloted a range of different tools for gathering insights against the indicators and functions with peer-led projects within seven organisations. The main aim was to identify what would be feasible within the resources of community and peer-led organisations.
The next phase of W3 will build on and extend this work by trialling and refining the W3 framework at an organisational level. We plan to recruit two peer-led organisations in HIV and hepatitis C to implement and trial the W3 framework across their entire organisation. This will include the development of practical and sustainable tools that use data and insights to improve the impact and quality of programs as well as share real-time knowledge with the broader sector and policy response.
The W3 project continues its aim to support community and peer-led organisations to demonstrate their quality and impact, adapt their programs to the rapid changes occurring in HIV and hepatitis C, increase their value-add to the overall sector response, and strengthen the evidence base to guide investment in community and peer-led health promotion programs.
The W3 Project is presenting in London on January 21
We will be providing an overview of our journey in the development and trialling of the W3 framework with our community partners, and discussing what we have learned. If you are in London come and join us. Thank you to our friends at Sigma Research.
Date: Thursday 21 January 2016
Time: 1:00 pm – 2:00 pm
Hosted by Sigma Research
Venue: Jerry Morris B, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
Full details about the seminar are at the following link
This article discusses the need for systems thinking to support HIV prevention policy and research to be more aligned to the complexity and messiness of the real word.
Brown, G., Reeders, D. Dowsett, G.W., Ellard, J., Carman, M., Hendry, N., and Wallace, J. (2015). Investigating combination HIV prevention: isolated interventions or complex system. Journal of the International AIDS Society, 18:20499. http://dx.doi.org/10.7448/IAS.18.1.20499 (Open Access)
Introduction: Treatment as prevention has mobilized new opportunities in preventing HIV transmission and has led to bold new UNAIDS targets in testing, treatment coverage and transmission reduction. These will require not only an increase in investment but also a deeper understanding of the dynamics of combining behavioural, biomedical and structural HIV prevention interventions. High-income countries are making substantial investments in combination HIV prevention, but is this investment leading to a deeper understanding of how to combine interventions? The combining of interventions involves complexity, with many strategies interacting with non-linear and multiplying rather than additive effects.
Discussion: Drawing on a recent scoping study of the published research evidence in HIV prevention in high-income countries, this paper argues that there is a gap between the evidence currently available and the evidence needed to guide the achieving of these bold targets. The emphasis of HIV prevention intervention research continues to look at one intervention at a time in isolation from its interactions with other interventions, the community and the socio-political context of their implementation.
To understand and evaluate the role of a combination of interventions, we need to understand not only what works, but in what circumstances, what role the parts need to play in their relationship with each other, when the combination needs to adapt and identify emergent effects of any resulting synergies. There is little development of evidence-based indicators on how interventions in combination should achieve that strategic advantage and synergy. This commentary discusses the implications of this ongoing situation for future research and the required investment in partnership. We suggest that systems science approaches, which are being increasingly applied in other areas of public health, could provide an expanded vocabulary and analytic tools for understanding these complex interactions, relationships and emergent effects.
Conclusions: Relying on the current linear but disconnected approaches to intervention research and evidence we will miss the potential to achieve and understand system-level synergies. Given the challenges in sustaining public health and HIV prevention investment, meeting the bold UNAIDS targets that have been set is likely to be dependent on achieving systems level synergies.
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.
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.
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.
Workshop in partnership with CEIPS on Thurs 12 March at VicHealth.
In evaluation research, a systems approach provides a conceptual vocabulary and toolkit for improving our understanding of the relationships among the social processes that make programs and interventions ‘work’ as a whole.
In the W3 project we used a systems approach to develop a mid-level program theory for peer and community based health promotion. Here is our theory:
peer-and-community-based health promotion programs mediate between two complex adaptive systems, their target communities and policy environment, and the programs need to fulfil four key functions – engagement, adaptation, influence and alignment – in order to remain effective and sustainable in a constantly changing environment.
In early March we held a workshop with our colleagues at the Centre of Excellence in Implementation and Prevention Science (CEIPS) on using a systems approach in evaluation research with community-based health promotion programs.