Evaluation of Public Health and Nutrition Programmes

Abstract

A proposal for a PhD study looking at the evaluation of public health and nutrition programmes within the UK. The number of such programmes has increased since the late 1990’s, and with them have developed strategies for evaluating their success. However, some suggest that evaluation so far has been flawed. This study aims to review evaluation practice through primary and secondary research, and thus contribute to best practice for future evaluation of health programmes.

1. Introduction

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Since the 1980’s there has been growing awareness of the impact of diet and other lifestyle factors on public health, however it is only since the 1990’s that the UK government has started to take an active role in promoting health and nutrition programmes (Caraher et al 2009). Since inception, there have been attempts to monitor and evaluate the success or failure of these programmes, however some have suggested (Hills 2004; Caraher et al 2009) that such evaluation has a number of flaws, particularly gaps in coverage and a lack of cohesiveness.

In the light of this, the following study aims to investigate the positive and negative features of the evaluation programmes which have looked at public health and nutrition programmes in the UK.It will combine a literature review investigating previous evaluations of UK-wide and local programmes with a primary phase gathering information from academics involved in evaluation research regarding their views of the advantages and disadvantages of the programmes. The overall aim of this research is to uncover gaps in evaluation procedure and suggest ways in which these might be addressed, in order to improve future practice.

2. Literature Review

2.1 Why public health and nutrition programmesGovernment Initiatives

Public health programmes have been in existence in the UK only since the 1980’s, and were slow to impact on a population more concerned with cheap, long lasting food products. However, as links between diet and health became more apparent, so did the need for the government to take a more active role (Caraher et al 2009)

This more active role started in the early 90’s, with the publication of ‘The Health of the Nation’ (DoH 1992). This report was followed by others including ‘Eat Well’ (Department of Health 1994) and ‘Our Healthier Nation’ (Department of Health 1998). Early attempts were less than successful, however (Caraher et al 2009).

The 1997 Labour Government, started to make public health programmes a central part of policy. Initially there was a focus upon the role played by the individual in making healthy choices, but this was followed by a recognition of the wider picture, the social, economic and environmental factors involved (Crawley 2008), for example the notion of ‘food poverty’ or ‘food inequality’ (Bunton and Macdonald 2002), the idea that financial poverty, poor diet and increased risk of diet-related illnesses are linked (Faculty of Public Health 2004)

Consequently, the later years of the Labour Government saw the publication of a range of public health and nutrition programmes, for example (in England) ‘Food Matters’ (2008) and in Scotland ‘Recipe for Success – Scotland’s National Food and Drink Policy.

2.2. Evaluation of Public Health Programmes – Strategy and Evidence

There are a number of research initiatives concerned with the evaluation of Public Health and Nutrition programmes in the UK. The National Institute for Health and Clinical Excellence (NICE) issue guidelines on assessment of health programmes, and five UK Clinical Research Collaboration Public Health Centres of Excellence work with a range of stakeholders and partners to examine public health issues. In addition the Social and Public Health Sciences Unit based at Glasgow University uncovers evidence in order to support best decisions about public health (NOO [online] 2011). The NHS also support a Public Health Research Programme with a multi-disciplinary and broad approach (NHS 2011).

The new government have also made changes to public health evaluation programmes, with a commitment to “the best evidence and evaluation” (DOH 2011, p. 8) through establishing a new National Institute for Health Research (NIHR), a School for Public Health Research, and a Policy Research Unit on Behaviour and Health (Department of Health 2010). They claim that previous attempts at evaluation have been insufficient, marked by lack of cohesion and lack of ‘localism’ (Department of Health 2010)

2.3 Evaluation of Public Health Programmes Successes and Failures

To what extent are the suggestions by the new government about current evaluation of health programmes supported by research evidenceSome writers do seem to suggest that policies have been poorly evaluated: A study of policies across Northern Ireland, Wales, Scotland and England found a lack of cohesion in policy and poor analysis of provision with gaps in existing evaluation (measurement of attitudinal and behavioural change, but far fewer assessments of changes to health).At the same time, evaluation is insufficiently tied in with guidance on future action, particularly on the way the food industry might be involved (Caraher et al 2009). A review by Hills (2004) suggested that while advances have been made in evaluation, there is still a need to improve on methods.

2.4 Research question

Within the UK, therefore, there has been a vast increase in the number of public health and nutrition programmes, from the large-scale and national to the small-scale and local. There also exist a number of projects concerned to evaluate these programs. However, opinions differ regarding the success of this evaluation, with many suggesting improvements could be made. This study therefore seeks to answer the following research question:

How successful have previous evaluation of public health and nutrition programmes been, and how could these evaluations be improved?

3. Methodology

3.1 Research Philosophy / Research Approach

The study takes a positivist approach, assuming that reality is objective and knowable, and that a deductive, scientific methodology is most appropriate (Babbie 2010).The study rejects an interpretivist viewpoint, or the idea that reality is primarily subjective (Knapp and Powers 2005).

3.2 Research Strategy / Data Collection and Analysis

The study will include both primary and secondary data. Secondary data, or information derived from already published sources (Wrenn et al 2006), will be accessed from government information, academic journals and other publications both online and through libraries. Where online databases are used, clear inclusion and exclusion criteria will be drawn up and appropriate keyword searches will be defined. In addition, the study will include a primary phase, to gather information from a number of respondents involved with the process of assessing public health programmes in the UK over the last 10 years. The primary phase will be shaped by information collected in the secondary phase. Questions will be designed to see if respondents agree with earlier findings, and to investigate areas neglected previously. The primary data will include quantitative, numerical data gathered by a questionnaire consisting of rating scales and single or multiple choice questions regarding experience of assessing public health programmes, tools used and other areas. It will also include a semi-structured element in order to assess in more detail respondents thoughts about the successes and failures of the programmes of which they were a part. Data will be analysed to produce descriptive statistics and analysis of significance. Textual data collected through the semi-structured questions will be subject to content analysis (Babbie 2010) by transferring the data and examining it for emerging themes.

3.3 Access / Significance / Ethical Issues

Access will be made by telephone contact with university departments and government organisations. There may be some ethical issues regarding confidentiality, as respondents may fear that any negative views they might hold about evaluation of public health programmes might filter back to their employer and lead to unwanted consequences. It will therefore be necessary to draw up a comprehensive confidentiality agreement in order to persuade participants and institutions to take part.

3.4 Research Limitations

The research is limited to one point in time, shortly after a new government has introduced new guidelines on the evaluation of public health programmes. A fuller evaluation might only be possible at a later point in time, once the new initiatives have been introduced.

4. Conclusion

The above sets out a framework for a research project concerned with the evaluation of public health and nutrition programmes within the UK. The rationale for the research has been discussed, and a literature review section indicates areas of concern. A methodology sets out the means to be employed in the study.

5. Time Chart

Activity Time Scale

1. Research Design
2. Planning
3. Literature Review
4. Refine Research Objectives
5. Design Questionnaires
6. Contact Organisations
7. Carry out Survey
8. Data Analysis
9. Dissertation Draft
10. Dissertation Final

6. References

1. Babbie, E R (2010), The Practice of Social Research (12th edn.), Cengage Learning, Belmont, CA.
2. Bunton, R and Macdonald, G (2002) Health promotion: disciplines, diversity, and developments (2nd edn.) Routledge, UK
3. Cahill, M and Fitzpatrick, T (2002) Environmental issues and social welfare
   Broadening perspectives on social policy (6th edn.), Wiley-Blackwell, Oxon
4. Caraher, M, Crawley, H and Lloyd, S (2009) ‘Nutrition Policies across the UK 2009’,
5. Caroline Walker Trust, Herts
6. Crawley, H (2008) ‘Public Health Nutrition: challenges for the 21st Century’,The Caroline Walker Trust, Herts.
7. Department of Health (1992) ‘Health of the Nation: A Strategy for Health in England’, HMSO, London
8. Department of Health (1994) ‘Eat Well! An Action Plan from the Nutrition Task Force to Achieve the Health of the Nation Targets on Diet and Nutrition’, HMSO, London
9. Department of Health (1998) ‘Our Healthier Nation: A Contract for Health. A Consultation Paper’, HMSO, London
10. Department of Health (2008) ‘Food Matters’, HMSO, London
11. Department of Health (2010) ‘Healthy lives, healthy people: our strategy for public health in England’, HMSO, London
12. The Faculty of Public Health of the Royal College of Physicians of the United Kingdom (2004) ‘Food Poverty and Health’, FPH, UK
13. Hills, D (2004) ‘Evaluation of community-level interventions for health improvement:
14. a review of experience in the UK’, Tavistock Institute / NHS Health Development Agency, UK.
15. Knapp, T R and Powers, B A (2005) Dictionary of Nursing Theory and Research, Springer, NY
16. National Obesity Observatory (2011) ‘Evaluation Websites’ [online] (cited 11th July 2011), available from
17. http://www.noo.org.uk/core/eval_websites National Obesity Observatory 2011 online
18. NHS (2011) ‘Research to improve the health of the public and reduce inequalities in health’, [online] (cited 10th July 2011), available from http://www.phr.ac.uk/
19. Wrenn, B, Stevens, R E and Loudon, L (2006) Marketing research: text and cases (2nd Edn), Routledge, UK

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