In work prior to the W3 project, we found that most intervention research in the area:

“… looks 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 play in their relationship with each other..” Brown et al (2015)

The What Works and Why (W3) Project wanted to really shift the capacity to demonstrate the role and influence that peer programs and their leadership play as part of a the HIV and hepatitis C response and its complex community and political systems. We needed a better way to describe our understanding from research and practice of what the program is or should be achieving – a better program theory to guide our evaluation and investment decisions.

Working in collaboration with ten peer-led organisations, and funded by the Commonwealth Department of Health, we used systems thinking and participatory methods to develop a better understanding of how peer-based programs work, formulating a framework to evaluate the role and contribution of peer-based programs and developing methods to best capture and share insights from practice.

Our partner organisations for W3 Stage 1 were:

  • Australian Federation of AIDS Organisations,
  • Australian Injecting and Illicit Drug Users League,
  • Harm Reduction Victoria,
  • Living Positive Victoria,
  • National Association of People Living with HIV/AIDS,
  • Positive Life NSW,
  • Queensland Positive People,
  • Scarlet Alliance – Australian Sex Workers Association,
  • Victorian AIDS Council, and
  • Western Australian Substance Users Association.

We conducted 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.

What systems thinking brought to the table was an understanding that for peer-led programs, the way communities respond, enhance, adapt, resist or ignore, interventions are part of the program, and that this something that should be leveraged. The systems thinking approach conceptualises peer-based programs, and the communities and policy environments they engage with, as complex adapting systems.

A presentation describing the W3 Framework is here

We then 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.

System Diagrams 

The following documents provides detailed descriptions  system logic diagram and draft indicators developed with the W3 Project partners. These should be read in conjunction with the above reports.

PWUD Peer Service Provision and Policy Participation System Logic and Draft Indicators

PLHIV Peer Leadership and Policy Participation System Logic and Draft Indicators

GMSM Peer Network Targeted Health Promotion System Logic and Draft Indicators

W3 Stage 1 Reports

Below are the key reports and summary documents from the first stage of W3

W3Stage1-Final Report-SummaryReport-25July2016_Page_01

W3 Stage 1 (2014-2016)-Summary Report

This includes a one page executive summary, an overview of the project and the W3 Framework, and a summary of the feasibility trials of the indicators and tools

W3Stage1-Final Report-Appendices-25July2016_Page_01

W3 Stage 1 (2014-2016)-Appendices

This includes a detailed methods section, detailed report on the feasibility trials, listing of the W3 presentations (national and international), and copies of selected tools.

W3 Framework ToolKit Guide for the Feasibility Trials

Using the W3 Framework in Practice-Version1_0_Page_01

Using the W3 Framework in Practice-Version1_0

This document is the W3 Framework guide used to support the development of tools during the feasibility trials

Other selected posts during W3 Stage 1

Reflections from a workshop on using a systems approach

End of Year 1 Wrap

Bringing systems thinking into conversation with realist evaluation and quality improvement

International Forum hosted by W3 at AIDS2014

More is different: how systems thinking might help achieve combination prevention (keynote at the 2014 AFAO conference)

Five surprising things we’ve learned about peer based programs