PBHL20004 Study Guide

PBHL20004: Public Health Action and Evaluation
Study Guide
Term 2 2021
Acknowledgements Wendy Madsen, Rebecca Fanany, Vivian Romero and Tafadzwa Nyanhanda
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Contents
Unit Overview......................................................................................................................................... 4
Prescribed Textbooks ............................................................................................................................. 4
Attendance Requirements ..................................................................................................................... 4
Preparation is key to success! ................................................................................................................ 5
Unit Weekly Activities ............................................................................................................................ 6
Assessment ........................................................................................................................................... 11
Assessment 1 .................................................................................................................................... 11
Assessment 2 .................................................................................................................................... 11
Assessment 3 .................................................................................................................................... 12
Academic Integrity ............................................................................................................................... 13
Week 1: Traditional public health action ............................................................................................ 14
Tutorial Discussion Questions.......................................................................................................... 15
Week 2: Behaviour change theories .................................................................................................... 16
Week 3: Planning public health action. ............................................................................................... 19
Week 4: Tools to help planning and evaluating public health actions............................................... 22
Tutorial Exercises for Weeks 4 and 5 ............................................................................................... 27
1. Developing S.M.A.R.T. objectives exercise ......................................................................... 27
2. Logic model exercise ............................................................................................................ 28
3. Identifying Indicators exercise ................................................................................................ 31
Week 5: Community Development ..................................................................................................... 32
Tutorial Discussion/Reflection ......................................................................................................... 33
Week 6: Healthy Settings ..................................................................................................................... 34
Tutorial Discussion: .......................................................................................................................... 34
Week 7: Public health advocacy and activism .................................................................................... 35
Tutorial Discussion/Reflection ......................................................................................................... 37
Week 8: Evaluation in public health .................................................................................................... 38
Tutorial Exercises.............................................................................................................................. 41
Week 9: Evaluation Design .................................................................................................................. 42
Tutorial Exercises for Weeks 9 and 10 ............................................................................................. 46
1. Developing evaluation question(s) for your intervention .................................................. 46
2. Evaluation Plan Template .................................................................................................... 48
Week 10: Evaluation Methods: Data collection, analysis and interpretation ................................... 49
Tutorial Exercises: Continue working on the exercises from Week 9. ........................................... 51
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Week 11: Evaluation Reporting: Disseminating results of evaluation. .............................................. 52
Tutorial Exercises.............................................................................................................................. 53
Week 12: Healthy Public Policy ........................................................................................................... 54
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Unit Overview
Public Health Action and Evaluation aims to provide students with key skills to encourage communities
to recognise and build on existing strengths, resources and networks that facilitate empowerment.
This requires effective partnership building with key leaders, community members and organisations.
This unit explores action to address disease prevention and health promotion - this is the 'what we
do' in public health. Using a Critical Realism framework, you will build on your skills in public health by
exploring systematic program planning incorporating assessment, implementation and evaluation.
Evidence-based practice is traditionally the key driver of action in health, including public health. In
this unit you will additionally explore the application of practice-based evidence acknowledging the
value and richness of data that can be gathered from real-world efforts in public health. You will have
opportunities to analyse and evaluate a range of public health interventions including innovative
approaches such as arts-based and decolonising approaches. These will allow you to explore the ethics
and practices associated with working with a range of communities, including Indigenous and
marginalised groups.
With participation and determination, over the next 12 weeks you will be able to:
1. Explain how complex adaptive systems and Critical realism influence project planning,
implementation and evaluation
2. Determine appropriate models of public health project management that account for
influencing factors at different scales
3. Evaluate public health actions and evaluations within First Nation Peoples communities in
regard to social and environmental determinants of health and principles of social justice,
equity and equality
4. Reflect on effective partnership development with others, including establishing relationships

and collaborative learning
5. Propose and justify a range of interventions to address a complex health issue and outline
how these interventions could be evaluated.
Prescribed Textbooks
Baum, F 2015, The new public health, 4th edition, Oxford University Press, Melbourne (also available
as e-book - library collection).
Harris, MJ 2017, Evaluating public and community health programs, Jossey-Bass, San Francisco (also
available as e-book - library collection).
Attendance Requirements
All on-campus students are expected to attend scheduled classes – in some units, these classes are
identified as a mandatory (pass/fail) component and attendance is compulsory. International
students, on a student visa, must maintain a full-time study load and meet both attendance and
academic progress requirements in each study period (satisfactory attendance for International
students is defined as maintaining at least an 80% attendance record).
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Preparation is key to success!
In order to do well in this unit, it is necessary to come to tutorials ready to work with and discuss the
material covered in the unit. A range of material is provided for you as part of this unit. Much of this
material can be found on the Moodle site for the unit and is presented in weekly sections that
correspond to the topic and activities for each week of the term. A unit timetable is contained in the
unit guide and is also available as a separate document on the Moodle site. It is important to be
familiar with the timeline for the unit and to refer to this timetable to ensure that you are up to date
and are covering the required material for each week of the term.
For each topic to be covered, there are required readings that are taken from your textbook or are
available through the Moodle site for the unit. In some cases, additional readings are suggested. You
must read the required readings for each week, and this must be done before your tutorial. You are
not required to read the suggested readings, but it would be very advantageous to do so because
they will provide you with additional background and knowledge. The readings come from journals
in the field of public health or from other academic texts. They were selected because they offer
insight into specific aspects of intercultural communication and personal practice. The authors of
these works are among the major figures in the field, and the readings selected reflect critical
understandings that have structured its development.
The lectures for this unit explicate the weekly topics and are intended to assist you to understand
and master the principles of the field that are reinforced by the readings. These lectures should be
the starting point of your weekly preparation. They are available on the Moodle site for the unit and
can be accessed at a convenient time and location on a device of your choice. This means you should
set aside time for viewing the lectures for the unit that fits with your schedule of classes and other
activities, but you are not required to attend a class in which a lecture will be presented. Viewing the
lectures is an important part of your preparation and should be a priority in approaching the
material.
Your classes for this unit will consist of a weekly tutorial taught in a two-hour block. This tutorial will
be student-focused and will be a chance for you to interact with classmates and your tutor, to
discuss the topics of the unit, and to develop insights through collaboration that can be applied in
your assessment tasks. For this reason, it is important to be ready to participate actively in tutorial
activities. This study guide, in addition to providing an overview of each week’s topic, contains
discussion points that will form the basis for tutorial activities. Space is given for you to record any
thoughts you have based on the lecture and your readings or to make any notes that will help you
recall important points that are relevant to the tutorial in question. You can do this by typing directly
in the electronic file containing the study guide or you can print a copy and make notes longhand.
The study guide is primarily for your own use but will be an important record of your thinking that
will assist you in your assessment as well as an indication of your activity in the unit that will allow
your lecturer to better support you if you need help.
You should feel free to contact me at any time if you need help or have questions about any aspect
of this unit. I can be reached by email at: t.nyanhanda@cqu.edu.au; by phone at:
(03) 9616 0408; or in person at Room 4.02 on the Melbourne Campus. Additionally, you can post
questions about the material in the discussion area of the Moodle site for the unit, which I will
answer in that same forum.
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Unit Weekly Activities
Week Weekly Topic Learning activities Assessment
Due
1 Traditional 1. Traditional public health interventions (levels of prevention;
Public Health screening; vaccination; Primary Healthcare)
action 2. Underpinning medical model that assumes causative thinking.
(Baum,2015:
Chapter 18) Readings
Baum, F. (2015). Medical and health Service Interventions. In F.
Baum, The New Public Health (pp. 479-499). South Melbourne:
Oxford University Press.
Moodle site:
What is public health video outlines traditional PH:
https://www.youtube.com/watch?v=t_eWESXTnic
Public health and 5 levels of prevention animation:
https://www.youtube.com/watch?v=igpmkppdu4U
Primary Health Care in an Aboriginal community (STI, DFV):
http://www.apunipima.org.au/component/content/category/57-
about
2 Behaviourism 1. Behaviour change approaches in public health (influence of Online
(Baum,2015: psychology; personal skills in Ottawa Charter) discussion
Chapter 19) 2. Main behaviour change models/theories: Health Belief Model;
Theory of Reasoned Action; Transtheoretical Model
3. Social marketing approach
4. Underlying assumptions (information changes behaviour;
individualism; rational decision-making)
Reading
Baum, F. (2015). Changing Behaviour: The limits of behaviourism and
some alternatives. In F. Baum, The New Public Health (pp. 500-523).
South Melbourne: Oxford University Press.
Moodle site:
Transtheoretical model stages of change animation:
https://www.youtube.com/watch?v=Twlow2pXsv0
Health Belief model animation:
https://www.youtube.com/watch?v=6SfTbTkEozA
Theory of Reasoned Action animation:
https://www.youtube.com/watch?v=nZsxuD3gExE
Myths associated with behavioural change but also includes how to
do promotional campaigns more effective:
https://www.youtube.com/watch?v=l5d8GW6GdR0
3 Planning public 1. Understanding context and its complexity Online
health action 2. Process (needs/assets assessment, planning intervention, discussion
(Baum,2015: implementation, evaluation)
Chapter 10) 3. Shift from positivism to critical realism as underlying philosophy
(from linear causality to mechanisms within open systems)
4. Implications of this shift (from expert to community-driven;
expansion of indicators beyond quantitative)
5. Stakeholder engagement
Readings
Baum, F. (2016). Planning and Evaluation of Community-based
Health Promotion. In F. Baum, The New Public Health (pp. 228-252).
South Melbourne: Oxford University Press.
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Harris, J. M. (2017). Developing initiatives: An overview. In J. M.
Harris, Evaluating Public and Community Health Programs (pp. 55-
84). Hoboken, NJ: John Wiley & Sons Inc.
Moodle site:
Overview of complex social interventions:
https://www.youtube.com/watch?v=t1pf6RJG4L0
Why we need to understand complexity of public health (away from
linear thinking) and importance of new perspectives:
https://www.youtube.com/watch?v=-Rm4QwsWEZM
Overview of health promotion in Victoria as example of shifting away
from tradition Public Health:
https://www.vichealth.vic.gov.au/about/health-promotion
4 Tools to help 1. Program Theory/Theoretical framework Online
planning 2. Developing aims and objectives discussion
3. Logic model and LogFrame as standard tools (what they look
like, how they work, how to develop)
4. Advantages (documenting process, easy to follow) and
disadvantages (level of detail, assumptions of causality)
Readings
Harris, J. M. (2017). Designing the Evaluation: Part 1: Describing the
Program or Policy. In J. M. Harris, Evaluating Public and Community
Health Programs (pp. 111-132). Hoboken, NJ: John Wiley & Sons Inc.
Harris, J. M. (2017). Developing initiatives: An overview. In J. M.

Moodle site:
Logic Model for public health:
https://www.youtube.com/watch?v=IHEp0gJRTwI
Theory of Change: It's Easier Than You Think:
https://youtu.be/wUiKdwgJpD8
Online resources:
White, Howard. (2009). Theory-Based Impact Evaluation: Principles
and Practice. New Delhi: International Initiative for Impact
Evaluation. https://brownschool.wustl.edu/Resources-and-
Initiatives/Professional-Development/Documents/White-3ie-
2009.pdf
CDC Community Toolbox logic model examples:
https://ctb.ku.edu/en/table-of-contents/overview/models-for-
community-health-and-development/logic-model-
development/example
Logic Model Development Guide: Using Logic Models to Bring
Together Planning, Evaluation, and Action. (2004). Battle Creek, MI:
W.K. Kellogg Foundation.
https://ag.purdue.edu/extension/pdehs/Documents/Pub3669.pdf
NSW developing a program logic
https://www.health.nsw.gov.au/research/Publications/developing-
program-logic.pdf
NSW Department of Premier and Cabinet. Evaluation Toolkit.
Available online: https://www.dpc.nsw.gov.au/toolsand-
resources/evaluation-toolkit/
5 Community 1. What is community development (Ledwith p. 5: vision, Online
development principles, values, process, collective action, theories, context) discussion
(Baum,2015: 2. Underlying concepts: social & environmental justice; equality;
Chapter 21) conscientisation
Readings
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Baum, F. (2016). Community Development in Health. In F. Baum, The
New Public Health (pp. 547-564). South Melbourne: Oxford
University Press.
Harris, J. M. (2017). The Community Assessment: An overview. In J.

M. Harris, Evaluating Public and Community Health Programs (pp.
23-54). Hoboken, NJ: John Wiley & Sons Inc.
Ledwith, M. (2016). Community Development in Action: Putting

Freire Into Practice, Policy Press.
Moodle site:
Sustainable community development based on strengths:
https://www.youtube.com/watch?v=a5xR4QB1ADw
Social change needs engaged communities not heroes:
https://www.youtube.com/watch?v=WdHBWL4LK88
6 Healthy 1. What is healthy settings approach, where is it employed and Online
settings why? discussion
(Baum,2015: 2. Importance of political leadership and will
Chapter 23) 3. Intersectoral partnerships and action
4. Healthy Cities movement (operationalisation of Ottawa Charter)
Readings
Baum, F. (2016). Healthy Settings, Cities, Communities and
Organisations: Strategies for the Twenty-first Century. In F. Baum,
The New Public Health (pp. 584-616). South Melbourne: Oxford
University Press.
Connelly, J. (2001). Critical realism and health promotion: effective

practice needs an effective theory, Health Education Research, 16,
(2), pp. 115-120.
Moodle site:
Edutainment resources:
Impact of built environment on health: Ted Talk
https://www.youtube.com/watch?v=F_M04dK5jx4
Ottawa healthy cities promo:
https://www.youtube.com/watch?v=1IBvf1ttMmc
WHO overview of healthy cities:
https://www.youtube.com/watch?v=IqluZPlako8
Vancouver’s healthy city strategy:
https://www.youtube.com/watch?v=0kcQ4JQyqek
7 Public Health 1. What is advocacy and how has it impacted public health? Online
advocacy and 2. Grassroots activism to developing social movements discussion
activism 3. Political lobbying
(Baum,2016: 4. Using the media for advocacy and activism purposes Assessment
Chapter 22) 1 Due
Reading
Baum, F. (2016). Public Health Advocacy and Activism. In F. Baum,
The New Public Health (pp. 565-583). South Melbourne: Oxford
University Press.
Moodle site:
Public being involved in public policy (having a bit of fun with it):
https://www.youtube.com/watch?v=wXYSsA5yVSY
8 Evaluation in 1. Role of evaluation in public health, including types of evaluation Group work:
Public Health (process, outcomes) Assessment
(Harris, 2017: 2. Insiders vs outsiders in evaluation Part 2A Due
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Chapters 3. Understanding influence of underpinning philosophy on
1,2,3,4) assumptions
Readings
Harris, J. M. (2017). An introduction to public and community health
evaluation. In J. M. Harris, Evaluating Public and Community Health
Programs (pp. 1-22). Hoboken, NJ: John Wiley & Sons Inc.
Harris, J. M. (2017). The Community Assessment. In J. M. Harris,

Evaluating Public and Community Health Programs (pp. 23-54).
Hoboken, NJ: John Wiley & Sons Inc.
Harris, J. M. (2017). Developing Initiatives: An overview. In J. M.

Harris, J. M. (2017). Planning for evaluation. In J. M. Harris,

9 Evaluation 1. Role of theoretical frameworks in evaluation
Design (Harris, 2. Deciding on a theoretical framework
2017: Chapters 3. Designing an evaluation study: different designs of evaluations,
5,6,7) data collection and analysis alignment with aims, objectives and
theory (Maxwell’s planning figure)
4. Rigour in evaluation
Readings
Harris, J. M. (2017). Designing the evaluation: Part 1: Describing the
program or policy. In J. M. Harris, Evaluating Public and Community
Harris, J. M. (2017). Designing the evaluation: Part 2A: Process

Evaluation. In J. M. Harris, Evaluating Public and Community Health
Harris, J. M. (2017). Designing the evaluation: Part 2B: Outcome

Evaluation. In J. M. Harris, Evaluating Public and Community Health
Moodle site:
Planning an evaluation animation:
https://www.youtube.com/watch?v=cG9OO7KpSKs&list=PLvM92u7r
KsZ9A7XCTRxLQimJdrvHy1wqh
(4 minutes)
Realist evaluation interview with Ray Pawson:
https://www.youtube.com/watch?v=YL39DAVNLBE (7 minutes,
another 3 after if interested)
10 Evaluation 1. Quantitative, qualitative and mixed methods
methods: Data 2. Who collects and analyses the data and when
analysis and 3. Participatory meaning making
interpretation
in evaluation Readings
(Harris, 2017: Harris, J. M. (2017). Collecting the Data: Quantitative. In J. M. Harris,
Chapters 8, 9,
10)
Harris, J. M. (2017). Collecting the Data: Qualitative. In J. M. Harris,
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Harris, J. M. (2017). Analysing and Interpreting Quantitative and
Qualitative Data. In J. M. Harris, Evaluating Public and Community
Harris, J. M. (2017). Reporting Evaluation Findings. In J. M. Harris,

Moodle site:
Tools and approaches animation:
https://www.youtube.com/watch?v=9V6u1qtsHaA
11 Evaluation 1. Why disseminate;
Reporting: 2. Avenues of dissemination
Disseminating
results of
Reading
evaluation
(Harris, 2017: Harris, J. M. (2017). Reporting Evaluation Findings. In J. M. Harris,
Chapter 11) Evaluating Public and Community Health Programs (pp. 271-288).
12 Healthy public 1. Policy environment with focus on economics and impact on Group work
policy (and health as consequence (alternative measuring wellbeing rather Assessment
healthy than GDP) Part 2B Due
economics 2. Policy formulation process, and influence of power and lobbying
policy) 3. Health in All Policies (HiAP) as alternative to traditional siloed Assessment 3
(Baum,2016: policy making Due:
Chapters 16 & Reflective
Readings practice
24)
Baum, F. (2016). Health Public Policy. In F. Baum, The New Public essay
Health (pp. 617-652). South Melbourne: Oxford University Press.
Baum, F. (2016). Healthy Economic Policies. In F. Baum, The New

Public Health (pp. 417-446). South Melbourne: Oxford University
Press.
Moodle site:
HiAP (Canada): https://www.youtube.com/watch?v=80oVVgfpTCw
(3 minutes)
Iona Kickbusch HiAP, South Australia:
https://www.youtube.com/watch?v=YqWAHOuHGTo (6 minutes)
Developing healthy public policy (focus on family planning in
Rwanda, but gives good overview):
https://www.youtube.com/watch?v=DAWjyaLo4D4 (21 minutes)
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Assessment
There are three assessment tasks for this unit.
Assessment 1
This is an INDIVIDUAL assessment. In Weeks 2-6 you will be required to submit a discussion forum
post of 150-200 words in relation to a specific question posed for each week, and respond to
another student’s comments (50-100 words)
These questions are:
1. Why have individual behaviour change approaches to public health dominated over the past 50
years and what have been the consequences on this domination for those who work from a
communitarian basis such as First Nations Peoples?
2. How has complex adaptive thinking influenced public health intervention planning?
3. Can complex social/public health interventions be effectively modeled with a single logic model?
Why or why not? Considering First Nations Peoples, how would you approach a task like this?
4. A community development approach is an effective approach when working with First Nations
people to plan and implement Public Health interventions partly because it ensures that the
communities have ownership and oversight of decisions regarding the public health
intervention. Reflecting on unit content and other literature, why are ownership and oversight
of decisions important factors in ensuring the success of interventions in these communities?
5. Critical realism influences project planning, implementation and evaluation, describe how it
influences healthy setting approaches to Public Health?
Please make sure you contribute to the forum PRIOR to the week’s tutorial, and reply to one other
discussion post, contributing to the learning of others by providing relevant new perspectives.
Assessment Due Date Week 6 Friday (27 Aug 2021) 11:45 pm AEST Forum posts are due each week
(Week 2,3,4,5,6), refer to schedule for details.
Assessment 2
This is a GROUP assessment. At the beginning of the term, you will pick a topic and join a team (5-6
people). It is strongly encouraged that you make use of the opportunities provided during the
tutorial sessions. Throughout the term, teams will plan a public health intervention that:
• Outlines inspiration (review of the literature, local government data, analogous experience)
• Reflects ideation (themes and insights from inspiration including but not limited to defining how
Aboriginal and Torres Strait Islander sections of the community are incorporated and how to
ensure that their voices are heard)
• Identifies strategies developed for the intervention
• Presents a logic model or logFrame
• Provides an evaluation plan including data collection, analysis and dissemination
• Offers an opportunity for reflection on effective partnership development
This assessment consists of two components:
1. Part A: Group presentation of your public health intervention plan.

Working in groups of up to 6, you need to plan a public health intervention within a chosen
scenario (scenarios will be provided in Moodle or in class). This will include:
• outlining assets and needs based on the literature and local government authority data;
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• developing a logic model or logFrame;
• identifying how Aboriginal and Torres Strait Islander sections of the community are
incorporated into the plan;
Presentation should be 10 minutes in duration. Presenters will be stopped if they go over 10

minutes. Submission of your presentation includes slides AND transcript of your presentation.
Each member of the team uploads the final group submission via Moodle.
2. Part B: Group presentation of your public health intervention evaluation plan

Continuing in your group and working on the same scenario, outline how your public health
intervention would be evaluated. This will include:
• provision of an evaluation plan including data collection and analysis and how results
will be disseminated;
• identifying what differences would need to be undertaken to ensure Aboriginal and
Torres Strait Islander voices are heard.
Presentation should be 10 minutes in duration. Presenters will be stopped if they go over 10
minutes. Submission of your presentation includes slides AND transcript of your presentation.
Only one member of the team will be allowed to upload this submission via Moodle.
Please note presentations will be done during tutorials week 8 for assessment 2A and week 12
for assessment 2B.
Uploading of presentation slides onto Moodle: Assessment Due Date: Part 2A Week 8 Friday (10
Sep 2021) 11:45 pm AEST, Part B is due Week 12 Friday (8 October 2021)
Assessment 3
This is an INDIVIDUAL assessment. Based on your informal reflections throughout the term, you will
explore your ability to develop effective partnerships with others, including establishing
relationships and collaborative learning. In a 2000-word essay, reflect on your group partnership
throughout the term. In your essay, you will need to focus on:
• The group process in establishing and maintaining relationships throughout the term
• The effectiveness and experience of collaborative learning within the group
• The relevance of this experience in undertaking community-based public health actions and
evaluations.
• A minimum of two appropriately cited references is required.
Assessment Due Date Review/Exam Week Wednesday (13 October 2021) 11:45 pm AEST
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Academic Integrity
In this unit, as well as in the rest of your course, you are expected to conform to the standards of
academic integrity in all assessment. This means that you must:
1. correctly cite all sources of information used;
2. clearly indicate which ideas are your own and which come from another source;
3. write in your own words, whether you are expressing your own idea or the idea of another
person; and
4. identify any phrases or sentences taken directly from a source as a direct quotation.
Failure to do these things constitutes plagiarism, a serious form of misconduct, that will have serious
consequences that include academic discipline measures.
Information on plagiarism is available on the University website and can be accessed at:
https://www.cqu.edu.au/student-life/services-and-facilities/referencing/what-is-plagiarism
It is your responsibility as a student to ensure that you understand what constitutes plagiarism and
to avoid it in all your work. All assignments in this unit will be checked with Turnitin, a text matching
software that checks your work against a huge database of online documents that includes papers
and assignments submitted to universities worldwide as well as journals articles, books, and
webpages. It is strongly encouraged that you check your own drafts with Turnitin. Refresh your
memory on how to use Turnitin at:
https://sportal.cqu.edu.au/__data/assets/pdf_file/0014/61610/Turnitin.pdf
Collusion, which means working together with another student on an assignment that is supposed to
be completed as an individual, is also a form of academic misconduct. In this unit, your second
assessment task must be completed individually, and you are not allowed to work with other
students on this task or to seek advice or help from any other person.
Information on all forms of academic misconduct, including plagiarism and collusion, can be
found at: https://sportal.cqu.edu.au/learning-support/student-guides/great-guide-to-university-
study
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Week 1: Traditional public health action
Health care approaches to health promotion concentrate on the prevention of disease mainly
through primary medical services (Baum, 2015). However, numerous barriers have been identiﬁed to
general practitioners (GPs) being more involved in prevention, including the fee-for-service
structure, short consultation times, the traditional focus of medicine on curative interventions and
GPs’ lack of health promotion skills and knowledge, and these have continued over the past three
decades (Bauman et al., 1989; Ward et al., 1991; Peckham et al., 2011).
However, in past decades it has been shown that interventions or health promotion efforts with the
greatest potential impact, are those that address socioeconomic determinants of health (Frieden,
2010). In addition, they tend to be more effective because they reach broader segments of society
and require less individual effort. Implementing interventions at each of the levels can achieve the
maximum possible sustained public health benefit. The benefit of medical interventions is that they
require limited contact but can confer long-term protection, ongoing direct clinical care, and health
education and counseling. Table 1 below describes the changing a dapproaches to promoting
health: from a traditional (biomedical) approach to one that considers underlying determinants of
health and how this impacts on strategic responses and evaluation of success.
Table 1: Evolving approaches to promoting health
There are 5 levels of prevention mainly categorized as primordial, primary, secondary, tertiary and
quaternary prevention.
Primordial prevention consists of actions to minimize future hazards to health thereby inhibiting the
establishment of factors which are known to increase the risk of disease (Pandve, 2014).
Primary prevention seeks to prevent the onset of specific diseases by reducing risk by altering
behaviors or exposures that can lead to disease or by enhancing resistance to the effects of
exposure to a disease agent (Pandve, 2014).
Secondary prevention includes procedures that detect and treat preclinical pathological changes and
thereby control disease progression. Screening of diseases is often the first step, leading to early
interventions that are more cost effective than intervening once symptoms appear (Pandve, 2014).
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Tertiary prevention seeks to soften the impact caused by the disease on the patient's function,
longevity, and quality-of-life (Pandve, 2014).
Quaternary prevention is defined as “action taken to identify patient at risk of over-medicalization,

to protect him from new medical invasion, and to suggest him interventions ethically acceptable.”
(Pandve, 2014).
References
Baum, F. (2015). Medical and health Service Interventions. In F. Baum, The New Public Health (pp.
479-499). South Melbourne: Oxford University Press.
Bauman, A., Mant, A., Middleton, L., Mackertich, M. and Jane, E. (1989) Do general practitioners
promote health? A needs assessment. Medical Journal of Australia, 151, 265– 269.
Frieden T. R. (2010). A framework for public health action: the health impact pyramid. American
journal of public health, 100(4), 590–595. https://doi.org/10.2105/AJPH.2009.185652
Pandve H. T. (2014). Quaternary prevention: need of the hour. Journal of family medicine and
primary care, 3(4), 309–310.
Peckham, S., Hann, A. and Boyce, T. (2011) Health promotion and ill-health prevention: the role of
general practice. Quality in Primary Care, 19, 317– 323.
Moodle site:
What is public health video outlines traditional PH:

https://www.youtube.com/watch?v=t_eWESXTnic (5 minutes)
Public health and 5 levels of prevention animation:

https://www.youtube.com/watch?v=igpmkppdu4U (3 minutes)
Primary Health Care in an Aboriginal community (STI, DFV):

http://www.apunipima.org.au/component/content/category/57-about (15 minutes)
Tutorial Discussion Questions

1. Reflect on the three approaches to health promotion described in Table 1: Traditional
(Biomedical), Behavioural, and Socio-ecological.
2. Give an example of each of these (preferably from your own experience)

o Describe the intervention. Where and when was it used, what was the context?
o What was it aiming to achieve?
o Was it effective? In what way/s?
o What possible limitations/gaps can you identify – in terms of how it was planned,
implemented, or its outcomes?
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Week 2: Behaviour change theories
Improving the health of populations may require changes in behaviour. A number of theories that
stem from social psychology have been developed by various researchers/practitioners that form the
basis of behavioural approaches to health promotion (Baum, 2015). They attempt to explain the
different variables that influence individual’s health behaviours such as attitudes, beliefs, motivations,
values and instincts. Early models of behaviour change assumed a link between knowledge, attitude
and behavior. Later sophisticated models of behaviour determinants and change were developed.
In this unit we will focus on three behaviour change models: Health Belief Model; Theory of Reasoned
Action and the Transtheoretical Model (Stages of change model).
The health belief model

It is based on the on the belief that when people consider changing a behaviour they do a cost-benefit
analysis, which includes assessing:
• the likelihood of illness or injury happening to them (susceptibility), for example, an individual
who has multiple sexual partners may assess their likelihood of contracting human
immunodeficiency virus (HIV) and determine if they would like to continue the risky behaviour.
• the severity of the illness or injury, for example, the individual may assess if they do contract HIV
whether will it result in further health complications or death.
• the likely effect of the behavior change (efficacy), for example, if I start exercising will I be able to
maintain the exercise and will I lose weight or achieve desirable health outcomes
• benefits of taking action
The theory of reasoned action

This model maintains that behaviour is governed by intention and that personal attitudinal and social
normative factors determine behaviour intention (Baum, 2015). An individual’s belief that a behaviour
leads to certain outcomes and their evaluation of the behaviour and associated outcomes results in
the person’s attitude toward a behaviour. On the other hand, there is social normative influence, the
individual’s perception of the opinions of the important others in their life, for example, their social
network, group beliefs, cultural norms and their motivation to comply results in subjective norm.
These two major influences; their attitude toward a behaviour and subjective norm combine to form
an ‘intention’ to behave in a certain way and this intention is predictive of behaviour.
Transtheoretical model (Stages of change)

People do not change their behaviour suddenly, completely and permanently. Prochaska &
DiClemente’s behavioural theory - Transtheoretical model is important as it shows that the changes
people make are only part of an ongoing process. The model suggests that people cycle and relapse
through five distinct stages.
1. Pre-Contemplation -Individual has no intention to change or denies need for change.

2. Contemplation -An individual is aware there is a problem. They are considering changing their
behaviour and are weighing perceived costs and benefits. However, there is no commitment to action.
3. Preparation -Individual is actively planning to change.
4. Action -Individual is making an attempt to change.
5. Maintenance -Individual is solidifying change and resisting relapse.
Understanding the different stages of change for addressing a particular public health issues is useful
in tailoring public health intervention strategies that are most effective at moving a person to the next
stage of change, and subsequently through the model to maintenance, the ideal stage of behaviour.
16
One of the major limitations of behaviour of change models is that they pay little attention to the
social, economic and cultural environments in which people’s behaviours occur. The socio-ecological
model of health (SEMH)acknowledges the influence of social, economic and cultural environments on
people’s behaviours and health outcomes. SEMH illustrates how an individual’s behaviour and health
is shaped by their social, economic and cultural environments and how too individuals also shape their
environments (Bronfenbrenner, 1977 & Stokols, 1996).
Social Marketing Approach

A social marketing approach applies marketing techniques to social psychology theories in order to
bring about population wide behaviour change (Baum, 2015). It is usually aimed at well-defined *(i.e.,
segmented) audiences offering a set of products and messages responsive to consumers’ wants and
needs.
and often includes the use of mass media.
Examples of mass media campaigns include walk to school (https://www.walktoschool.vic.gov.au/),

this girl can (https://thisgirlcan.com.au/) and Kick the habit
(https://www.ahmrc.org.au/publication/kick-the-habit-social-marketing-campaign-elders-package/ )
References:
Baum, F. (2015). Changing Behaviour: The limits of behaviourism and some alternatives. In F. Baum,
The New Public Health (pp. 500-523). South Melbourne: Oxford University Press.
Bronfenbrenner U. (1977). Toward an experimental ecology of human development. American

psychologist.;32(7):513.
Stokols D. (1996) Translating social ecological theory into guidelines for community health promotion.
American journal of health promotion.;10(4):282-98.
Prochaska, James & Diclemente, Carlo. (1983). Stages and Processes of Self-Change of Smoking -
Toward An Integrative Model of Change. Journal of consulting and clinical psychology. 51. 390-5.
10.1037//0022-006X.51.3.390.
Moodle Site
Transtheoretical model stages of change animation:

https://www.youtube.com/watch?v=Twlow2pXsv0 (5 minutes)
Health Belief model animation: https://www.youtube.com/watch?v=6SfTbTkEozA (4 minutes)
Theory of Reasoned Action animation: https://www.youtube.com/watch?v=nZsxuD3gExE (4 minutes)
Myths associated with behavioural change but also includes how to do promotional campaigns more
effective: https://www.youtube.com/watch?v=l5d8GW6GdR0 (18 minutes)
17
1. What public health programs that take a primarily behavioural approach have you been involved
in or know about?
2. Reflecting on this public health program what worked, what did not, what underpinning
behaviour change theory was used?
3. What myths and assumptions associated with individual behaviour change public health
interventions (where have these come from?)
18
Week 3: Planning public health action
Community-based initiatives that seek to address a public health issue in a particular community
should focus on social, policy, organizational and individual change (Baum, 2015). However, such
initiatives pose challenges to planning and evaluation as they are:
i. Not amenable to evaluation using conventional methods such as Randomized Control Trials
as there is difficulty in finding a “control” community.
ii. Typically, long-term developmental activities that seek to change the ways in which
organisations work.
iii. Are complex, involving multiple activities with evolving and changing objectives.
To understand the complexity of addressing a public health issue, review the causal loop diagram/
systems thinking diagram in the publication by Allender et al., 2016. The researchers conducted group
modeling sessions with various community stakeholders to investigate the causes of childhood obesity
in a rural Australian community. A causal loop diagram can provide the basis for community led
planning of a prevention response that engages with multiple levels of existing settings and systems.
The systems map or causal loop diagram in the publication reveals the complexity of determining the
priority issue or action to be addressed first, as well as designing and implementing community based
public health interventions. Public health interventions are usually based on the social and
environmental understanding of health (socio-ecological model of health) and therefore it is
important to use this framework in any public health intervention planning work.
It is important to acknowledge the broadness of the new public health agenda, which means that
decisions about which health issues to tackle is critical as practitioners must choose between many
competing priorities. In order to set priorities and to plan accordingly, it is important to determine the
needs of the community in question. Many interventions start with an assessment of needs – variously
called needs assessment, situational analysis, community diagnosis or rapid appraisal (Harris, 2017).
Needs assessment typically should be wide ranging, involving several government sectors, community
groups and private industries. Without planning – public health actions will be reactive; responding to
threats to health as they arise rather than planning for and creating health.
It important in planning and needs assessment for the sole focus NOT to be on problems – problem
driven needs assessment can be disempowering to communities. Especially poor communities where
low self-esteem can be reinforced and where the potential for a negative portrayal is greatest (Baum,
2015).
When working with First Nations people, it is important to be sensitive to community perspectives,
perspectives and solutions from within a community have a far greater chance of informing effective
plans than external perspectives (Baum, 2015). Sometimes health professionals can fall into the trap
of defining need in terms of their own solutions. Planning is useful and effective if it involves a broad
section of the community and makes sure that the community involvement is not tokenistic. It is
important to encourage a sense of common or shared vision in planning as it helps to keep all
stakeholders focused and committed (Harris, 2017). The benefits of involving community members in
the planning exercise are that they know their community well and have perspectives that differ from
those of paid professionals.
When conducting a needs assessment, audit what information is routinely available such as
demographic health surveys, local council reports, community assessment reports (quantitative and
qualitative data), these data will be useful in helping identify gaps in knowledge and determination of
additional information required to fill gaps. This information may include prevalence and incidence of
19
disease, quality-of-life indicators, risk and protective factors that influence the behaviour of
individuals, sociocultural and political factors that reinforce or enable conditions that increase the
public health problem and will affect any interventions and the assets and resources available within
the community (Baum, 2015).
Using a combination of qualitative and quantitative data can improve planning and evaluation by
ensuring that the limitations of one type of data are balanced by the strengths of another. This will
ensure that understanding is improved by integrating different ways of knowing. Combining
qualitative and quantitative data can result in more understanding of the systemic nature of issues,
ensure community involvement fostering detailed dialogue among community groups and between
the community and technical experts therefore preventing sole reliance upon the assessment of
experts, result in heightened understanding of the technical aspects and complexities of problems
enabling stakeholders and residents to define effective options for action.
Establishing priorities to be addressed should be based on the information collected during the needs
assessment, other considerations should be taken into account such the particular interests of the
project staff and members of the steering or management group; political interest or lack of interest
in particular topics; issues considered important by the community; and local policies relating to
health and previous work in the area.
Appropriate planning frameworks are needed for ongoing strategic thinking. Planning frameworks
need to be capable of coping with the complexity of change and should be broad enough to equip
communities and health promoters with the ability to respond to locally defined illness problems and
health issues and to establish priorities for action.
References
Baum, F. (2015). Planning and Evaluation of Community-based Health Promotion. In F. Baum, The New
Public Health (pp. 228-252). South Melbourne: Oxford University Press.
Harris, J. M. (2017). Developing initiatives: An overview. In J. M. Harris, Evaluating Public and

Community Health Programs (pp. 55-84). Hoboken, NJ: John Wiley & Sons Inc.
Allender S, Owen B, KuhlbergJ, Lowe J, Nagorcka-Smith P, et al. (2015) A Community Based Systems
Diagram of Obesity Causes. PLOS ONE 10(7): e0129683.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0129683
Moodle site:
Overview of complex social interventions: https://www.youtube.com/watch?v=t1pf6RJG4L0 (6

minutes)
Why we need to understand complexity of public health (away from linear thinking) and importance
of new perspectives: https://www.youtube.com/watch?v=-Rm4QwsWEZM (10 minutes)
Overview of health promotion in Victoria as example of shifting away from tradition PH:
https://www.vichealth.vic.gov.au/about/health-promotion (4 minutes)
20
This week you will work in your groups for your Assessment 2A. Start thinking of the different
sources of data you need to collect to conduct a needs assessment or asset mapping for the
community you are designing for your programfor. Write down the potential data sources and/or
how you will obtain data.
1. What key differences can you identify between expert-led public health interventions and
community-based public health interventions
2. Consider the strengths and limitations of each. What are the implications of each approach for
o Planning
o Implementation
o Evaluation?
21
Week 4: Tools to help planning and evaluating public health actions.
In week 2 you learnt about behaviour change theories, in most cases these theories underpin your
intervention design. Using a theoretical framework, provides a structure upon which a health
intervention can be designed and subsequently can be used to monitor changes. When a theory is
used as the basis for the intervention, the goals and objectives follow the constructs of the theory
(Harris, 2017).
Examples of how you can use a theoretical framework to guide the design of your intervention.
Taken from Harris, J. M. (2017). Developing initiatives: An overview. In J. M. Harris, Evaluating Public and Community Health Programs (pp.
55-84). Hoboken, NJ: John Wiley & Sons Inc.
22
After identifying the public health priorities in a particular community following a needs assessment,
you can proceed to design your public health intervention. When designing your intervention, you
need to clearly state the goal and objectives that your intervention wants to achieve.
A goal is defined as a broad statement of intended outcomes for a program or intervention.
Example
– To increase the physical activity participation of school going children in grades 1-12 in
Victoria by 10%
An objective is a statement of intended outcomes that is focused and time-specific (that is,
achievable in a specified time frame).
Examples
- By September 2025, at least 80% of all school going children in grades 1-12 will be
participate in local council funded physical education program offered at their schools
twice a week.
- By May 2021, all physical education curriculum teachers in Victoria State will receive
training on how to engage students in physical activity.
When determining the objectives of your intervention, they will need to be S.M.A.R.T:
• Specific: Clear and precise

• Measurable: amenable to evaluation
• Attainable: Realistic
• Result-oriented and relevant: to the health issue, the population group and your
organisation
• Time-bound: time frame for achieving outcomes.
Review Appendix 1, it will guide you on how to develop S.M.A.R.T objectives.
Program Logic Model
After determining the program/intervention goal and objectives, the next step is usually developing
a program logic model. A program logic model is one of the tools that helps in planning and
evaluating an intervention. Ideally, a logic model is used at the start of planning a program to ensure
alignment between the purpose of the program, the inputs, the activities and the intended
outcomes. This allows stakeholders to articulate the desired program impacts and outcomes and
clarify how the intervention will achieve these.
A program logic model is a schematic representation that describes how a program is intended to
work by linking activities with outputs, intermediate impacts and longer-term outcomes.
Why is a program logic important?
• It aims to show the intended causal links for a program.

• It presents a picture of how your effort or initiative is supposed to work.
• It explains why your strategy is a good solution to the problem at hand.
23
• It shows the logical relationships among the resources that are invested, the activities that
take place, and the benefits or changes that result.
• It is the core of program planning, evaluation, program management and communications.
• Is a useful tool for engaging stakeholders in program planning and evaluation, and clearly
communicating with stakeholder audiences about program concepts?
• It builds common understanding, especially about the relationship between actions and
results.
• Communicates what your program is (and is not) about.
• Forms a basis for evaluation.
Developing a program logic model:
Developing a program logic model involves identifying aims, objectives, activities and intended
impacts/outcomes, and refining and assembling these statements into a causal chain that shows
how the activities are assumed to contribute to short-term and intermediate impacts and,
ultimately, to longer term outcomes (NSW Government Evaluation Toolkit). The process of
developing program logic should involve working with a range of stakeholders to draw on their
understanding of the program and its impacts/outcomes as well as encouraging ownership of the
final program logic model.
Program logic model components:
(W.K. Kellogg Foundation,2004)
i. Goal(s)
ii. Objective(s)
iii. Resources: inputs needed design and implement activities. These include time, people (staff,
volunteers), money, materials, equipment, partnerships, research base, and technology among
other things. These inputs allow us to create outputs.
iv. Activities: the actions that are needed to meet your objectives.
v. Outputs: the tangible and direct results of activities. Outputs are "what we do" or "what we
offer." They include workshops, services, conferences, community surveys, facilitation, in-home
counseling, etc. These outputs are intended to lead to specific outcomes.
24
vi. Outcome(s): specific, attainable and measurable changes that are likely to occur as a result of
activities. Outcomes are the direct results or benefits for individuals, families, groups,
communities, organizations, or systems. Examples include changes in knowledge, skill
development, changes in behavior, capacities or decision-making, policy development.
Outcomes can be short-term, medium-term, or longer-term achievements. Outcomes may be
positive, negative, neutral, intended, or unintended.
vii. Assumption(s): Assumptions are the beliefs we have about the program and the people involved
and the way we think the program will work. This is the "theory" we are talking about: the
underlying beliefs in how it will work. These are validated with research and experience.
Assumptions underlie and influence the program decisions we make. Assumptions are principles,
beliefs, ideas about: The problem or situation, the resources and staff, the way the program will
operate, What the program expects to achieve, the knowledge base, the external environment,
the internal environment, the participants: how they learn, their behavior, motivations, etc.
The environment in which the program exists includes a variety of external factors that can influence
the program's success. External factors include the cultural milieu, the climate, economic structure,
housing patterns, demographic patterns, political environment, background and experiences of
program participants, media influence, changing policies and priorities. These external factors may
have a major influence on the achievement of outcomes. We can't ignore them! They may affect a
variety of things including the following: Program implementation, Participants and recipients, the
speed and degree to which change occurs, Staffing patterns and resources available. These factors
interact with the program. They not only influence the initiative but are influenced by the initiative.
A program does not sit in isolation - somehow "outside" or "apart" from its surrounding
environment. A program is affected by and affects these external factors.
How to read a program logic model
Reading a logic model means following the chain of reasoning or “If...then...” statements which
connect the program’s parts. The below illustrates how you read or understand a program logic.
(W.K.
Kellogg Foundation,2004)
25
What is a LogFrame?
A table giving a clear and synthetic picture of the project goal, purpose, outputs and activities, their
respective indicators and sources of verification as well as assumptions/risks which could affect the
project implementation.
Intervention logic Indicators Data source Assumptions
Goal (Impact):
Purpose/Objectives (Outcomes):
Outputs:
Activities:
What is an Indicator?
It is a specific, observable, and measurable accomplishment or change that shows the progress
made toward achieving a specific output or outcome in your logic model or work plan. Indicators are
essential instruments for monitoring and evaluation and are objectively verifiable measurements.
A strong indicator should include these four elements:
• How much. Identify the amount of change among your target population that would
indicate a successful level of achievement.
• Who? Specify the target population you will measure.
• What. Describe the condition, behaviour, or characteristic that you will measure.
• When. Note the timeframe in which this change should occur.
An example of a strong indicator
26
References
Harris, J. M. (2017). Designing the Evaluation: Part 1: Describing the Program or Policy. In J. M.
Harris, Evaluating Public and Community Health Programs (pp. 111-132). Hoboken, NJ: John Wiley &
Sons Inc.
Harris, J. M. (2017). Developing initiatives: An overview. In J. M. Harris, Evaluating Public and

Moodle site:
Edutainment:
Logic Model for public health: https://www.youtube.com/watch?v=IHEp0gJRTwI (10 minutes)
Theory of Change: It's Easier Than You Think: https://youtu.be/wUiKdwgJpD8
Online resources:
White, Howard. (2009). Theory-Based Impact Evaluation: Principles and Practice. New Delhi:
International Initiative for Impact Evaluation. https://brownschool.wustl.edu/Resources-and-
Initiatives/Professional-Development/Documents/White-3ie-2009.pdf
CDC Community Toolbox logic model examples: https://ctb.ku.edu/en/table-of-

contents/overview/models-for-community-health-and-development/logic-model-
development/example
Logic Model Development Guide: Using Logic Models to Bring Together Planning, Evaluation, and
Action. (2004). Battle Creek, MI: W.K. Kellogg Foundation.
https://ag.purdue.edu/extension/pdehs/Documents/Pub3669.pdf
NSW developing a program logic https://www.health.nsw.gov.au/research/Publications/developing-

program-logic.pdf
NSW Department of Premier and Cabinet. Evaluation Toolkit. Available online:

https://www.dpc.nsw.gov.au/toolsand-resources/evaluation-toolkit/
Tutorial Exercises for Weeks 4 and 5

1. Developing S.M.A.R.T. objectives exercise
Exercise 1: Using the guiding questions for developing SMART objectives (appendix I), determine
which is a S.M.A.R.T objective.
Exercise:
Goal 1: To decrease the dropout rate of at-risk students in grades 9-12 at Achievers High School.
27
Objective 1.1: As a result of the program attendance rates at Achievers High School will be at 100%.
Objective Specific Measurable Achievable Result- Timebound

oriented
and relevant
(realistic)
As a result of the
program Yes Yes Yes Yes Yes
attendance rates
at Achievers High
School will be at No revise No revise No revise No revise No revise
100%.
Attendance rates
at Achievers High Yes Yes Yes Yes Yes
School will
increase by 20%
one year after No revise No revise No revise No revise No revise
the
apprenticeship/
coaching
program is
established.
Attendance rates
for at-risk youth Yes Yes Yes Yes Yes
at Achievers High
School at grades
10, 11, & 12 will No revise No revise No revise No revise No revise
increase by 2%
one year after
the
apprenticeship/
coaching
program is
established.
Adapted from West Virginia department of education (https://wvde.us/wp-content/uploads/2018/04/SMARTobjectives-
GuidingQuestions.pdf)
Now working in your groups, develop a SMART goal and objectives for your public health
intervention group assessment. If stuck ask your tutor for guidance.
2. Logic model exercise

Building a logic model for your intervention
i. Assumptions/Rationale: The assumptions that underlie a program’s theory are conditions

that are necessary for the success of your intervention, and you believe already exist – they
are not something you need to bring about with your program activities.
Exercise:
You have been approached to develop an intervention that seeks to reduce the consumption of
sugar-sweetened beverages by school going children in a particular community.
28
What may be some of the assumptions?
1. Parents know the harmful effects of consumption of sugar-sweetened beverages
2. Parents will comply and reduce consumption of sugar-sweetened beverages in their households
3. Supermarkets will increase the price of sugar-sweetened beverages to reduce purchase
Reflect on these and discuss your thoughts.
Now working on your public health intervention group assessment, what are the assumptions that
you have made that are necessary for the success of your intervention?
29
Review your lecture notes and readings, then proceed working in your groups and develop a logic
model for your intervention. You can use the logic model template below.
Program Name:
Problem Statement: What public health issue do we want to address?
Program goal:
Program objectives:
Resources Activities Outputs Short-term Intermediate Long-term

What resources What happens What are the Outcomes Outcomes Outcomes
do we have to in our tangible What changes do What changes do we What changes
work with? organization? products of our we expect to occur want to see occur do we hope to
activities? within the short after that? see over time?
term?
Rationale(s): Assumptions:
The explanation of a set of beliefs, based on a body of knowledge, about how change Facts or conditions you assume to be true.
occurs
30
3. Identifying Indicators exercise
A strong indicator statement should include these four elements:
• How much. Identify the amount of change among your target population that would indicate a
successful level of achievement.
• Who? Specify the target population.
• What. Describe the condition, behaviour, or characteristic that you will measure.
• When. Note the timeframe in which this change should occur.
Example:
For example, an outcome of a workplace food and beverage policy that restricts the provision of
sugar sweetened beverages in the workplace canteen and vending machines.
One indicator for that outcome would be the statement:

2% decrease of the number workers with a BMI >30 within twelve months of the policy being
implemented.
Breaking down the statement into the elements above, you see:
How Much = 2%
Who = workers
What = decrease in BMI
When = within twelve months of implementing the program
Start thinking of your intervention and how you will measure success.
While developing your indicators, you may realize that your outcomes are unclear or ambiguous.
This process offers an opportunity to reconsider or further clarify your outcomes.
Complex outcomes can have multiple indicators.
31
Week 5: Community Development
What is a community?
A community can be defined as people who live in a defined geographic locality, and/or who share a
sense of identity or have common concerns’ (Fry and Baum, 1992, p. 297).
4 characteristics of a community are (Baum, 2015):
• a spatial dimension (this could be a street, township, suburb, online)

• non-spatial dimensions (interests, issues, identities) for example netball club, young mothers baby
groups
• social interactions that are dynamic and bind people into relationships with one another (Public
Health Associations, colleagues in a workplace)
• identification of shared needs and concerns that can be achieved through a process of collective
action (political party, environmental action group).
Increasingly people participate in online, virtual communities transcend geography.
What is community development?
Community development is about community members taking the lead and deciding how they want
their community to be, taking collective action on how to make it a better place. Community
development empowers community members and creates stronger and more connected
communities. Community development is a holistic approach grounded in principles of
empowerment, human rights, inclusion, social justice, self-determination and collective action
(Kenny, 2007).
Ledwith, 2016 describes community development as being is rooted in a vision of a fairer and more
just world; based on the principles of social justice (works towards a more equal, inclusive society)
and environmental justice (calls for action to redress exploitation of the environment by capitalism).
Social justice and environmental justice are intertwined, for instance the poorest and most
vulnerable of the world are the ones who are most immediately affected by environmental
degradation or climate change. Community development should be based on trust, dignity, respect,
equality, reciprocity, and mutuality. An ideology of equality, where everyone has the right to trust,
dignity and respect formed out of experiences that are equal, reciprocal and mutual (Ledwith, 2016).
This leads to cooperative relationships that work together to connect people in ways that build
towards a participatory democracy.
Critical consciousness is central to community development, involving a process of becoming critical,

questioning everyday life and its contradictions. In a process of action and reflection, community
development grows through a diversity of local projects that address issues faced by people in
community (Ledwith, 2016). Through campaigns, networks alliances and movements of change, this
collective action develops a local/global reach that aims to transform the structures of oppression
that diminish local lives.
Practice cannot be understood without it being contextualized in its political times. This exposes the
way that power is structured into the fabric of society to advantage some people and disadvantage
others as the basis of empowering practice. Community development initiatives enable community
members to become more empowered, so they can increasingly recognise and challenge conditions
and structures that disempowerment them or negatively impacting their wellbeing (Ife, 2016).
32
Community Development Approach can be applied to many different areas:
• Health
• Education
• Town planning
• Enterprise development
Examples where community development strategies have been used.
• Central Australian Aboriginal Congress

• Work of development agencies e.g., World Bank, UNDP
Readings
Baum, F. (2016). Community Development in Health. In F. Baum, The New Public Health (pp. 547-
564). South Melbourne: Oxford University Press.
Fry D., Baum F. (1992) Keywords in community health. In Baum F., Fry D., Lennie I.(eds), Community
Health Policy and Practice in Australia. Pluto Press, Sydney
Harris, J. M. (2017). The Community Assessment: An overview. In J. M. Harris, Evaluating Public and
Ife, J. (2016). Community development in an uncertain world: Vision, analysis and practice (2nd ed.).
Port Melbourne: Cambridge University Press.
Kenny, S. (2007). Developing Communities for the Future (3rd ed.). South Melbourne: Thompson
Ledwith, M. (2016) Community Development in Action: Putting Freire Into Practice, Policy Press
Moodle site:
Sustainable community development based on strengths:

https://www.youtube.com/watch?v=a5xR4QB1ADw (18 minutes)
Social change needs engaged communities not heroes:

https://www.youtube.com/watch?v=WdHBWL4LK88 (14 minutes
Tutorial Discussion/Reflection
Read Morley, S. (2015), What works in effective Indigenous community-managed programs and
organisations (CFCA Paper No. 32). Melbourne. Australian Institute of Family Studies. (Retrieve
report from Australian Institute of Family Studies here). Reflecting on this report and unit
content, what makes indigenous community-managed programs and organisations more effective in
delivering public health interventions in First Nations communities?
33
Week 6: Healthy Settings
Drawing from Sanitary Science and influenced by the Public Health Act, Sir Benjamin Ward
Richardson (a close friend of John Snow) proposed a city design in 1876 where noxious uses were
separated from living areas. Hygeia’s lasting effects can be seen in the discrete separation of land
uses (i.e., industrial from residential). This planted the seed of recognizing the distinct relationship
between our surroundings and our health.
A proponent of miasma theory, Frederick Law Olmstead (father of US landscape architecture)

believed in the investment of public parks “outlets for foul air and inlets for pure air”. Urban parks
were referred to as the lungs of the city. The design of Central park in NY serves as testament to his
belief that the quality of the physical environment had profound influence on health.
A healthy settings approach is placing health promotion in the setting. The World Health
Organisation defines setting as “the place or social context in which people engage in daily activities”
in which multiple factors affect health and wellbeing. The approach focuses on the setting to
enhance and facilitate healthy(er) behaviours. The first question that is asked is what creates health
in our settings? To answer this question, you may need to draw upon a system thinking lens to
connect the relationships between health and settings.
‘WHO Healthy Cities Projects’ are characterised by broad-based, intersectoral political commitment
to health and wellbeing in its deepest ecological sense; commitment to innovation; an embrace of
democratic community participation; and a resultant healthy public policy (Duhl et al. 1999). These
Healthy Cities projects have been superseded. As discussed in Global Public Health, the UN
Sustainable Development Goals respond to the planets most pressing conditions with Goal 11
focusing on Sustainable Cities and Communities. https://sdgs.org.au/goal/sustainable-cities-and-
communities/
References
Duhl, L.J, Sanchez, A.K & World Health Organization. Regional Office for Europe. (1999). Healthy
cities and the city planning process: a background document on links between health and urban
planning / by L.J. Duhl and A.K. Sanchez. Copenhagen: WHO Regional Office for
Europe. https://apps.who.int/iris/handle/10665/108252
Olmsted, F. L. (1870). Public parks and the enlargement of towns. In C. E. Beveridge, C. F. Hoffman, &
K. Hawkins (Eds.), The papers of Frederick Law Olmsted. Supplementary series
Writing on public parks, parkways and park systems (pp. 171–205). Baltimore, MD: Johns Hopkins
University Press.
Tutorial Discussion:
• What could help people to be healthier?
• How can the environment change to be more supportive and empowering?
• How can we involve others in making the change?
Weeks 6-7 – tutorial class
Working in your groups, design your intervention plan. Please take this time to consult your
lecturer for guidance.
34
Week 7: Public health advocacy and activism
Advocacy is the act of taking a position on an issue and initiating actions in a deliberate attempt to
influence private and public policy choices (Baum, 2015). Public health advocacy usually refers to the
process of overcoming major structural (as opposed to individual or behavioural) barriers to public
health goals. Public health advocacy is often defined as the process of gaining political commitment
for a particular goal or program and identified by some as a critical population health strategy
(Chapman, 2004). When addressing public health issues, it is necessary to steer public attention away
from disease as a personal problem to health as a social issue, and the mass media are an invaluable
tool in this process. Decision-makers, policymakers, program managers, and more generally, those
that are in a position to influence actions that affect many people simultaneously tend to be the target
audiences of public health advocacy.
Public health advocacy blends activism, science and politics with a social justice value orientation to
make the system work better, particularly for those with least resources or disadvantaged (Baum,
2015). Laverack (2013, p. 1) defines activism as an “action on behalf of a cause, action that goes
beyond what is convention or routine”.
Public health advocates and activists can be individuals in their role as concerned citizens,
organisations and coalitions of organisations. Collaboration is a big piece of advocacy—because most
advocacy is grassroots and starts small. Grassroots advocacy is an ideal starting place for community
engagement, but it also requires collective voices to build power for advocacy to be impactful.
Organisations can form coalitions as individual organizations but might not have the capacity to
advance a specific agenda alone but they may be well positioned to build an aspect of the movement.
Key public health objectives public health advocacy tries to address:
• new law and regulations

• enforcement of existing laws and regulations, including stronger penalties.
• more funding for programs
• tax rises or reduction on products to depress or increase demand.
• changing clinical or institutional practices
• having other sectors direct energy at a health issue.
Advocacy strategies are wide-ranging. These can involve “…creating and maintaining effective
coalitions, the strategic use of news media to advance a public policy initiative and the application of
information and resources to effect systemic changes that change the way people in a community live.
It often involves bringing together disparate groups to work together for a common goal.” (Gomm,
2006).
Media Advocacy is one of the most common advocacy strategies used to advocate on health-related
issues. It can be used to enlist public sentiment to support a desired change. One of the main
challenges is for advocates to get their activities reported in the mainstream media. Social media
plays an important role as it enables advocates to bypass the mainstream print and electronic media
to spread advocacy messages and organize campaigns.
Other Key Advocacy and Activism Strategies
• Boycotts
• Public protests
• Non-violent direct action
35
• Picketing
• Civil disobedience
• Public art
• Petitions
Adapted from: Baum, F. (2016). Public Health Advocacy and Activism. In F. Baum, The New Public Health (pp. 500-523). South Melbourne:
Oxford University Press.
References
Baum, F. (2016). Public Health Advocacy and Activism. In F. Baum, The New Public Health (pp. 565-
583). South Melbourne: Oxford University Press.
Chapman S. Advocacy for public health: A primer. Journal of Epidemiology and Community Health
2004; 58:361-5
Gomm M, Lincoln P, Pikora, T, Giles-Corti, B. Planning and implementing a community-based public

health advocacy campaign: A transport case study. Health Promotion International 2006;21(4):284-92.
Laverack (2013) Health activism: Foundations and strategies
Moodle site:
Public being involved in public policy (having a bit of fun with it):
https://www.youtube.com/watch?v=wXYSsA5yVSY (7 minutes)
36
Tutorial Discussion/Reflection
Why has extensive advocacy and activism around closing the gap regarding Aboriginal and Torres
Strait Islander health had limited success?
Weeks 6-7: tutorial class
Working in your groups, design your intervention plan. Please take this time to consult your
lecturer for guidance.
37
Week 8: Evaluation in public health
Public Health initiatives or interventions aim to create social and physical environments that promote
good health. They should be assessed to determine if they are making an impact in improving the
quality of life of people and communities through the elimination or the reduction in the incidence,
prevalence, and rates of disease, and disability.
What is evaluation?
“The systematic collection of information about the activities, characteristics, and outcomes of
programs to make judgments about the program, improve program effectiveness, and/or inform
decisions about future program development.”
CDCs Introduction to Program Evaluation for Public Health Programs
Evaluations should be done for and with specific intended primary users for specific, intended uses
e.g., for accountability–to clients, community, funders, social justice –to ensure vulnerable
populations receive appropriate and effective services.
The goal of evaluation is to improve a program; thus, no evaluation is good unless the results are used.
The purposes of evaluation are:
• To assess the extent to which a program is being implemented

• To determine if an initiative is making or has made impact
• To provide information for the development of the initiative or replication of the program
• To determine cost effectiveness of program compared others
• Provide information about risk and protective factors
• To assess alternative approaches for the prevention or treatment of health problems
Types of evaluation
Evaluation activities may occur at multiple points on a continuum – from planning the intervention,
through implementation, to assessing the effects of populations served. The figure below shows the
different types of evaluation.
Harris, J. M. (2017). An introduction to public and community health evaluation. In J. M. Harris, Evaluating Public and Community Health
38
1. FORMATIVE evaluation can be conducted during the development or delivery of a
program/intervention. Information obtained can provide feedback for program improvement.
2. PROCESS evaluation is usually done to determine whether program or policy is being
implemented appropriately or to determine the extent to which the program is being
implemented as planned.
3. OUTCOME evaluation is conducted to determine the effect of the program or policy and is
performed at the end of the intervention or at a time predetermined by its outcome objectives.
The appropriate time for an outcome evaluation is determined by the timeline associated with
the program objectives.
4. IMPACT evaluation is conducted to determine extent to which initiatives have contributed to a
population-level effect.
Outcome and impact evaluation are often used interchangeably. However, for this unit, outcome
evaluation will be used for short-, medium- and long-term changes that can occur during the first few
years of program/policy implementation, while impact evaluation is conducted to determine long
term changes in the quality of life at the local, state and national levels that can be detected by
surveillance methods.
Engaging Stakeholders
It important to engage stakeholders to determine what type of evaluation is needed and the
appropriate evaluation questions to be addressed. As mentioned earlier, evaluations should be done
for and with specific intended primary users for specific, intended uses.
It is important to identify key stakeholders of the public health initiative or program.
There are 3 basic categories of stakeholders:

• those involved in program operations: Staff, managers, and other partners who are directly
involved in day-to-day activities of getting tasks done are those involved in program operations.
• those served or affected by the program: beneficiaries, community groups
• the intended users of the evaluation: may include policy makers, managers, administrators,
advocates, and funders
Stakeholders play an important role in:
39
• Framing and selecting the appropriate evaluation questions
• Identifying concepts that are critical to measure
• Developing and executing the evaluation plan
Who should conduct the evaluation?

INTERNAL Evaluators
Community based, or low resourced organizations usually rely on in-house evaluators. It can be done
by program employees. This has the advantage that program employees have knowledge of the
program, however this has the potential of creating bias and influencing evaluation findings.
EXTERNAL Evaluators
To minimize bias and influencing evaluation findings, an organization can commission external
evaluators to conduct an evaluation. This is usually done for a fee. However, outsiders have to gain
entry; and have less firsthand knowledge of the program.
Evaluation standards
One of the primary purposes for using the standards is to help design the “best” evaluation for a
program or situation. There is no one “right” evaluation. Instead, when designing the evaluation, one
should make choices that best suit a particular situation so that the result is the optimal program
evaluation for the program or initiative.
The four standards: utility, feasibility, propriety, and accuracy when applied will result in the most
worthwhile evaluation for the situation. Review the figure below - under each standard is a question
that can be asked to help design the evaluation. By applying the standards, one will have an evaluation
that is useful, feasible, proper and accurate for the program evaluation that one is conducting at this
time.
Adapted from Harris, J. M. (2017). An introduction to public and community health evaluation. In J. M. Harris, Evaluating Public and
References
Read the following to contribute to the online and tutorial discussions.
Harris, J. M. (2017). An introduction to public and community health evaluation. In J. M. Harris,

Evaluating Public and Community Health Programs (pp. 1-22). Hoboken, NJ: John Wiley & Sons Inc.
40
Harris, J. M. (2017). The Community Assessment. In J. M. Harris, Evaluating Public and Community
Harris, J. M. (2017). Developing Initiatives: An overview. In J. M. Harris, Evaluating Public and

Harris, J. M. (2017). Planning for evaluation. In J. M. Harris, Evaluating Public and Community Health
Tutorial Exercises
Process versus Outcome Evaluation Exercise
i. Process Evaluation
How do we know the processes are working well? Measuring efficiency will help you understand
some things about your process.
ii. Outcome Evaluation
How much have you done?
How big is the change that you have achieved? Are you on track to achieve your longer term
objectives?
Read the penguin case study – Social Policy Evaluation and Research Unit. (2017) Making sense of
evaluation: A handbook for everyone - Using Evidence for Impact.
https://dpmc.govt.nz/publications/making-sense-evaluation-handbook-everyone. Identify and list
the indicators that would need to be measured for process and outcome evaluation
Process Evaluation Indicators Outcome Indicators
Please note: The tutorial this week will also be used for student presentations. These presentations
will be done as a group, and all members of each group are expected to participate.
41
Week 9: Evaluation Design
Recap of week 8
Purpose of process evaluation is:
• to assess the extent to which the intervention is implemented with fidelity to the plan.
• to develop a sufficient understanding of how the intervention works to be able to develop it
further or create a blueprint for replication.
Unlike a process evaluation, which assesses the implementation of the initiative, outcome
evaluation assesses its effects.
Review the six steps framework for project evaluation below:
42
The program logic is the basis for designing the evaluation questions. It provides information about
the program or policy inputs (resources) and activities and outputs that allow the formulation of
questions for a process or outcome evaluation.
Indicators are crucial in evaluation as they help determine or monitor the progress or impacts of
program activities. Please review the notes in week 4 as the topic of indicators was covered.
When you have decided on the appropriate indicators, you need to determine the data sources and
data collection methods– where and how will you gather the information.
Below is an example of a Logframe showing details on indicators and data sources?
PROJECT SUMMARY INDICATORS DATA SOURCE
Goal 10% increase in the number of Grades Percentage of Grades 5-6 Comparison of primary and
5-6 primary students continuing on to primary students continuing on high school enrolment records.
high school within 3 years. to high school.
Outcome Improve reading proficiency among Reading proficiency among Six monthly reading proficiency
children in Grades 5-6 by 20% within 3 children in Grades 5-6 tests using the national
years. assessment tool.
Outputs 500 Grade 5-6 students with low reading Number of students completing Summer camp attendance
proficiency complete a reading summer a reading summer camp. records.
camp
Activities Run five reading summer camps, each Number of summer camps run. Summer camp records.
with 100 Grades 5-6 students who have
low reading proficiency.
43
There are many ways in which you might collect data as part of the evaluation. The data collection
methods you choose must align with your information needs. Once you know the kinds of
information you need to answer your evaluation questions, you can then explore appropriate data
collection methods that align with your budget and available expertise and resources.
There are different evaluation designs, evaluators need to determine the appropriate design for the
evaluation given the context and available data:
Randomized designed, also called experimental design, are the most rigorous evaluation design and
are often referred to as the gold standard.
Quasi-experimental designs – This design is used when randomization of subjects or groups is

neither practical nor feasible. It involves conducting a pre-test (i.e., measuring variables before
implementation of an intervention) or post-test (i.e., measuring variables after implementation of an
intervention or end of intervention). This design involves identifying a comparison group, which can
be done through matching - a process of identifying individuals that are similar to the participants in
the intervention group on all relevant characteristics, such as age, sex, religion, and other factors
44
associated with program exposure. It is necessary to assess any differences at the baseline to
account for any demographic or behavioural differences in the analysis.
Non-experimental design consists of an intervention group only and lacks a comparison/control

group. This is the weakest study design. Without a comparison group, it can be difficult for
evaluators to determine what would have happened in the absence of the intervention. A non-
experimental design is chosen when there are resource constraints, unable to form an appropriate
comparison group, or when a program covers the entire population and thus there is no comparison
group, such as with a mass media campaign.
There are four commonly used types of non-experimental designs:
• Pre-test/post-test designs, the intervention group is surveyed before and after the intervention.
While changes in outcome indicators may be observed among the intervention participants, they
cannot attribute all these changes to the intervention alone as there is no comparison group.
• Time-series designs look for changes over time to determine trends. The intervention group is
observed multiple times before and after the intervention and trends are analysed before and
after.
• Longitudinal study is another type of time-series design. Repeated measures of the same
variables from the same people are taken.
• Post-test only design, the intervention group is observed at one point in time after the
intervention, focusing particularly on comparing responses of sub-groups based on
characteristics such as age, sex, ethnicity, education or level of exposure to the intervention. This
is the weakest approach.
References
• Centre for Disease Control and Prevention, Framework for Program Evaluation in Public Health
(1999) MMWR 48, 4
• Harris, J. M. (2017). Designing the evaluation: Part 1: Describing the program or policy. In J. M.
Harris, Evaluating Public and Community Health Programs (pp. 111-132). Hoboken, NJ: John
Wiley & Sons Inc.
• Harris, J. M. (2017). Designing the evaluation. Part 2B: Outcome Evaluation. In J. M. Harris,
Evaluating Public and Community Health Programs (pp. 172-192). Hoboken, NJ: John Wiley &
Sons Inc.
• Harris, J. M. (2017). Designing the evaluation: Part 2A: Process Evaluation. In J. M. Harris,
Evaluating Public and Community Health Programs (pp. 133-170). Hoboken, NJ: John Wiley &
Sons Inc.
Moodle site:
• Planning an evaluation animation:

https://www.youtube.com/watch?v=cG9OO7KpSKs&list=PLvM92u7rKsZ9A7XCTRxLQimJdrvHy1
wqh
• (4 minutes)
• Realist evaluation interview with Ray Pawson:
https://www.youtube.com/watch?v=YL39DAVNLBE (7 minutes, another 3 after if interested)
45
Additional readings
Randomized designs
Wilkinson, SA & McIntyre, HD (2012), Evaluation of the 'healthy start to pregnancy'early antenatal
health promotion workshop: a randomized controlled trial. BMC pregnancy and childbirth. 12 (1), p.
131. Link
Quasi-experimental designs
Bresó, E, Schaufeli, WB & Salanova, M (2011) Can a self-efficacy-based intervention decrease

burnout, increase engagement, and enhance performance? A quasi-experimental study. Higher
Education. 61(4), pp. 339-55. Link
Non-experimental designs
Carter, M-A & Swinburn, B (1999). Measuring the impact of a school food programme on food sales
in New Zealand. Health promotion international, 14 (4) pp. 307-16. Link
Tutorial Exercises for Weeks 9 and 10

1. Developing evaluation question(s) for your intervention
a. First determine stakeholders and think about their information needs from the
evaluation or about the program. Make a list of the stakeholders
i.
ii.
iii.
iv.
etc
b. For the purposes of your group assessment determine your primary intended user(s)
and their information needs
Primary Intender User Information Needed Intended Uses

• • •
• • •
• • •
• • •
• • •
c. Based on your intervention, your list of high-priority stakeholders and high-priority

information needs, as well as your information needs, what are your possible evaluation
questions? Determine if it is a process or outcome evaluation.
46
Evaluation Question Process or Outcome Evaluation
1.
2.
3.
4.
5.
d. For each evaluation question and think about ways you might answer that question. Will
your method be qualitative, quantitative or both? What is your evaluation design? How
will you analyse the data?
47
2. Evaluation Plan Template
For each evaluation question and think about ways you might answer that question. Will your method be qualitative, quantitative or both? What is your
evaluation design? How will you analyse the data?
Indicator(s)
Evaluation question(s) Data collection method(s) Data Sources Methods of Data Analysis
What critical questions do What will indicate success for What tools will you use to From whom and where will it How will the data collected
you want to address? the objective? collect the information you be collected? be analysed? (frequencies,
need? chi-squares, thematic
analysis)
48
Week 10: Evaluation Methods: Data collection, analysis and
interpretation
Data needs have to be determined early. Data collection needs to specific and deliberate.
Source of evaluation information
• Existing information e.g., demographic surveys, national records, program administrative data
• People e.g., surveys, interviews, focus group discussions.
• Pictorial records and observations
Factors influencing data collection.
• Appropriate method – There is nneed to determine the most appropriate method that provides
the best information to answer the evaluation question given the resources available.
• Suitability of the sources – Careful attention must be paid to determine the source of
information/data important to ensure credibility.
• Theoretical framework – It is important to understand the theoretical framework used to
develop the program intervention, by understanding the underpinning theory, one can
develop/determine the appropriate research tools.
• Quality and quantity of data collected - Data quality: data should be valid and reliable –
determined by the authenticity of the source and the data collection method used. It is
important to note that the accessibility and availability of data will affect its quality.
• Staffing and time available – The number of staff available for data collection and their data
collection technical skills and whether they have they been trained in the data collection
methods.
Data Collection methods
Please take time to review the data collection methods listed below.
49
Mixed Methods
Mixed methods combine qualitative and quantitative in a systematic and synergistic way to answer
the evaluation question. Qualitative and quantitative data can be collected at the same time
(concurrently) or one after the other (sequentially).
 Example: Program aiming to improve the nutritional status of under fives
 Mixed Method:
 logs of activities and participation in feeding programs
 Household surveys
 In depth interviews with primary care givers
 Focus groups with women of childbearing age
 Observations of the community
Sample size and selection
Sample - consists of population units, things, organizations, geographical areas, etc. that have the
characteristics of interest to the researcher.
Sampling methods
Random Methods Non-random Methods
Probability sampling Convenience sampling
Cluster sampling Purposive sampling
Systematic sampling Snowball sampling
Stratification sampling
Sample size for data collection is determined by the research approach.
Data Analysis
The type of data collected will determine type of analysis conducted:
Examples of Quantitative data analysis types
 Descriptive statistics: frequencies, percentages, proportions, means.

 Inferential statistics: Correlation, Regression, Analysis of variance (ANOVA)
Examples of Qualitative data analysis types
 Thematic analysis
More detail on the data analysis types is covered in PBHL20006.
50
References
Harris, J. M. (2017). Collecting the Data: Quantitative. In J. M. Harris, Evaluating Public and
Harris, J. M. (2017). Collecting the Data: Qualitative. In J. M. Harris, Evaluating Public and Community
Harris, J. M. (2017). Analysing and Interpreting Quantitative and Qualitative Data. In J. M. Harris,
Evaluating Public and Community Health Programs (pp. 243-270). Hoboken, NJ: John Wiley & Sons
Inc.
Harris, J. M. (2017). Reporting Evaluation Findings. In J. M. Harris, Evaluating Public and Community
Moodle site:
Tools and approaches animation:
https://www.youtube.com/watch?v=9V6u1qtsHaA (3 minutes)
Tutorial Exercise:
Continue working on the exercises from Week 9.
51
Week 11: Evaluation Reporting: Disseminating results of evaluation.
Disseminating Information
Evaluations are conducted primarily to provide decision makers with informed options for improving
programs.
Why dissemination?
 Evaluations done to provide information on program effectiveness.

 To inform decision makers
 Accountability
Audience
You need to know for whom the information is intended. This will help you tailor the report
appropriately: report format, level of detail, type of presentation (oral or written) and timing of
report.
Audience can include: • Staff • Board • Funders • Partners • Other agencies • Public
Dissemination channels
You need to decide on the appropriate dissemination channel, which is appropriate for your target
audience. These can include:
• Detailed written report.

• Summaries of evaluation findings
• Brochure on lessons and recommendations
• Annual report
• Article in technical or organizational newsletter
• News release
• Press conference and Media appearance.
• Public meeting, public debate
• Seminar, workshop, or group discussion
• Electronically (e- mail, Internet, websites)
Additional points to consider:
• Anonymity of participants
• Sensitivity of information reported.
• Confidentiality of the report
• Objectivity
Readings
Harris, J. M. (2017). Reporting Evaluation Findings. In J. M. Harris, Evaluating Public and Community
52
Tutorial Exercises
Disseminating Evaluation Results
Make a list of the audiences with whom you would share the results of the evaluation. Next to each
audience, write how you might share the results (i.e., in what format).
Audiences Dissemination method
53
Week 12: Healthy Public Policy
What is Policy?
Policy is about taking decisions, setting goals and ways of achieving them and taking action or not to
achieve these goals. It results from an interaction between:
Policy is a process, not something that can be determined by a single event or decision. It is complex,
takes place on multiple levels- national, state, local.
What is Healthy public policy?
Healthy public policy is characterised by an explicit concern for health and equity in all areas of
policy and by accountability for health impact. The main aim of healthy public policy is to create a
supportive environment to enable people to lead healthy lives.
World Health Organization, 1988
Healthy public policy identifies the limitations of behavioural approaches to health promotion and
puts emphasis on policies in all sectors to ensure protection from disease and injury and promotion
of health. It aims to create socioeconomic and physical environments in which people can live
healthy lives and make healthy choices so that quality of life, well-being and health are enhanced.
Key features of healthy public policy:
• Multisectoral
• Should involve commerce and industry, voluntary organisations, the community and all tiers
of government
• Risks to public health are international
• ‘Make the healthy choices the easy choices’
• Action for healthy public policy: through formally organised lobby groups or the actions of
local community health initiatives
• Healthy public policy is an intrinsically political activity.
Draper (1991)
Processes needed for the successful adoption of healthy public policies include:
• Clear evidence about adverse effects on health – a particular issue

• Effective lobby groups in favour of policy and legislation to control the source of the adverse
effects on health
• Winning of support for policy and legislation change from key opinion leaders, including the
media and politicians
• Supportive bureaucratic players in key positions
• A policy environment that supports government intervention to change social and economic
structures in order to promote health
• Wins both for health and the other sectors involved.
54
Health in All Policies
The European Union has coined the term ‘Health in All Policies’ to promote healthy public policy
then taken up by WHO. Health in All Policies (HiAP) is a way of thinking about policymaking while
considering the social and environmental impact of its decisions.
Taken from Public Health Institute: Health in All Policies: A Guide for State and Local Governments
References
Baum, F. (2016). Health Public Policy. In F. Baum, The New Public Health (pp. 617-652). South
Melbourne: Oxford University Press.
Baum, F. (2016). Healthy Economic Policies. In F. Baum, The New Public Health (pp. 417-446). South
Melbourne: Oxford University Press.
Draper, P. (ed) (1991) Health through public policy. Green Print, London.
Public Health Institute: Health in All Policies: A Guide for State and Local Governments :
http://www.phi.org/wp-
content/uploads/migration/uploads/files/Four_Pager_Health_in_All_Policies-
A_Guide_for_State_and_Local_Governments.pdf
55
World Health Organization (WHO) (1988) Healthy public policy: The Adelaide recommendations.
World Health Organization (WHO) (2013b) The Helsinki Statement on Health in All Policies. 8th
Global Conference on Health Promotion, 10– 14 June, Helsinki, Finland.
Moodle site:
HiAP (Canada): https://www.youtube.com/watch?v=80oVVgfpTCw (3 minutes)
Iona Kickbusch HiAP, South Australia: https://www.youtube.com/watch?v=YqWAHOuHGTo (6

minutes)
Developing healthy public policy (focus on family planning in Rwanda, but gives good overview):
https://www.youtube.com/watch?v=DAWjyaLo4D4 (21 minutes)
Please note: The tutorial this week will also be used for student presentations. These presentations
will be done as a group, and all members of each group are expected to participate.
Appendix I
Source: West Virginia department of education (https://wvde.us/wp-content/uploads/2018/04/SMARTobjectives-

GuidingQuestions.pdf)
56

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PBHL20004: Public Health Action and Evaluation

4. Reflect on effective partnership development with others, including establishing relationships

Harris, J. M. (2017). Developing initiatives: An overview. In J. M.

Harris, J. M. (2017). The Community Assessment: An overview. In J.

Ledwith, M. (2016). Community Development in Action: Putting

Connelly, J. (2001). Critical realism and health promotion: effective

Harris, J. M. (2017). The Community Assessment. In J. M. Harris,

Harris, J. M. (2017). Developing Initiatives: An overview. In J. M.

Harris, J. M. (2017). Planning for evaluation. In J. M. Harris,

Harris, J. M. (2017). Designing the evaluation: Part 2A: Process

Harris, J. M. (2017). Designing the evaluation: Part 2B: Outcome

Harris, J. M. (2017). Reporting Evaluation Findings. In J. M. Harris,

Baum, F. (2016). Healthy Economic Policies. In F. Baum, The New

These questions are:

This assessment consists of two components:

1. Part A: Group presentation of your public health intervention plan.

Presentation should be 10 minutes in duration. Presenters will be stopped if they go over 10

2. Part B: Group presentation of your public health intervention evaluation plan

1. correctly cite all sources of information used;

Table 1: Evolving approaches to promoting health

Quaternary prevention is defined as “action taken to identify patient at risk of over-medicalization,

What is public health video outlines traditional PH:

Public health and 5 levels of prevention animation:

Primary Health Care in an Aboriginal community (STI, DFV):

Tutorial Discussion Questions

2. Give an example of each of these (preferably from your own experience)

The health belief model

The theory of reasoned action

Transtheoretical model (Stages of change)

1. Pre-Contemplation -Individual has no intention to change or denies need for change.

Social Marketing Approach

Examples of mass media campaigns include walk to school (https://www.walktoschool.vic.gov.au/),

Bronfenbrenner U. (1977). Toward an experimental ecology of human development. American

Transtheoretical model stages of change animation:

Health Belief model animation: https://www.youtube.com/watch?v=6SfTbTkEozA (4 minutes)

Theory of Reasoned Action animation: https://www.youtube.com/watch?v=nZsxuD3gExE (4 minutes)

Harris, J. M. (2017). Developing initiatives: An overview. In J. M. Harris, Evaluating Public and

Overview of complex social interventions: https://www.youtube.com/watch?v=t1pf6RJG4L0 (6

Tutorial Discussion Questions

A goal is defined as a broad statement of intended outcomes for a program or intervention.

• Specific: Clear and precise

Review Appendix 1, it will guide you on how to develop S.M.A.R.T objectives.

Program Logic Model

Why is a program logic important?

• It aims to show the intended causal links for a program.

Developing a program logic model:

Program logic model components:

(W.K. Kellogg Foundation,2004)

How to read a program logic model

Intervention logic Indicators Data source Assumptions

A strong indicator should include these four elements:

An example of a strong indicator

Harris, J. M. (2017). Developing initiatives: An overview. In J. M. Harris, Evaluating Public and

Logic Model for public health: https://www.youtube.com/watch?v=IHEp0gJRTwI (10 minutes)

Theory of Change: It's Easier Than You Think: https://youtu.be/wUiKdwgJpD8

CDC Community Toolbox logic model examples: https://ctb.ku.edu/en/table-of-

NSW developing a program logic https://www.health.nsw.gov.au/research/Publications/developing-

NSW Department of Premier and Cabinet. Evaluation Toolkit. Available online: