Perspectives in Public Health最新文献

Aims: This article critically discusses the purpose, pragmatics and politics of conducting commissioned evaluations on behalf of public sector organisations by drawing on the experience of evaluating a community-based 'whole systems' obesity prevention intervention for an English local council.

Methods: The study presented in this article incorporated two approaches: an evaluability assessment that interrogated the theoretical and practical difficulties of evaluating the intervention in a non-political way, and a retrospective analysis using Soft Systems Methodology that interrogated the more political difficulties of conducting such an evaluation in the 'real world'. The information and insights that enabled these reflections came from over 3 years of working closely with the programme team, attending and participating in stakeholder events and meetings, presenting to the Council's Scrutiny Committee meetings, four interviews with the programme manager, and multiple face-to-face group meetings, email exchanges and telephone conversations.

Results: The study reveals and analyses three key inter-related challenges that arose during the evaluation of the 'whole systems' obesity prevention intervention: the programme's evaluability, the evaluation purpose, and the nature, role and quality of evidence.

Conclusions: The evaluability assessment was important for defining the programme's theoretical and practical evaluability, and the retrospective analysis using Soft Systems Methodology enabled a greater understanding of the political tensions that existed. Key learning points related to the challenges that arose during this evaluation have broad applicability.

Aims: Obesity contributes to morbidity and early mortality, affecting people of all ages and sociodemographic backgrounds. Despite attempts to address obesity, efforts to date have only had limited success. Adopting a whole systems approach (WSA) may potentially address obesity and emphasise complex inter-relating factors beyond individual choice. This study aimed to assess implementation of WSA to diet and healthy weight in two council areas of Scotland, longitudinally exploring enablers and barriers. One area followed a Leeds Beckett WSA model (LBM) of implementation, while the other used a hybrid model incorporating existing working systems.

Methods: To assess the process of implementing a WSA, interviews and focus groups were conducted after initiation and 1 year later.

Results: Main enablers included: belief in WSA effectiveness; positive relationships between key personnel; buy-in at community and national levels; funding availability; the working group responsible for coordinating the system development comprising individuals with diverse expertise; good communication; and existing governance structures. Barriers included: insufficient funding; high staff turnover; inadequate training in WSA methodology; engaging all relevant stakeholders and reverting to 'old ways' of non-WSA working. The LBM provided a framework for system setup and generating an action plan.

Conclusion: This study provides the first independent longitudinal process evaluation of WSAs that have incorporated Leeds Beckett methodology, and offers insights into how a WSA can be implemented to address diet and healthy weight.

Aims: To explore existing regulatory mechanisms to restrict hot food takeaway (HFT) outlets through further understanding processes at local and national levels.

Methods: The Planning Appeals Portal was utilised to identify recent HFT appeal cases across England between December 2016 and March 2020. Eight case study sites were identified using a purposive sampling technique and interviews carried out with 12 professionals involved in planning and health to explore perceptions of and including factors that may impact on the HFT appeal process. Additionally, documents applicable to each case were analysed and a survey completed by seven Local Authority (LA) health professionals. To confirm findings, interpretation meetings were conducted with participants and a wider group of planning and public health professionals, including a representative from the Planning Inspectorate.

Results: Eight case study sites were identified, and 12 interviews conducted. Participants perceived that LAs would be better able to work on HFT appeal cases if professionals had a good understanding of the planning process/the application of local planning policy and supplementary planning documents; adequate time and capacity to deal with appeals cases; access to accurate, robust, and up to date information; support and commitment from elected members and senior management; good lines of communication with local groups/communities interested in the appeal; information and resources that are accessible and easy to interpret across professional groups.

Conclusions: Communication across professional groups appeared to be a key factor in successfully defending decisions. Understanding the impact of takeaway outlets on health and communities in the long term was also important. To create a more robust appeals case and facilitate responsiveness, professionals involved in an appeal should know where to locate current records and statistical data. The enthusiasm of staff and support from senior management/elected officials will play a significant role in driving these agendas forward.