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The Healthy Communities Initiative (HCI) has been established and funded through the Department of Health and Ageing (DoHA) to help promote healthy lifestyle choices. The Cradle Coast Authority (CCA) was successful in securing HCI funding to support local government and community networks in the delivery of health and lifestyle programs and activities to residents of the nine municipal council areas on the northwest coast of Tasmania. In January 2013, The University Department of Rural Health (UDRH) was engaged by the CCA to undertake the evaluation over a five-month period. Findings from evaluation would provide the funding body and key stakeholder organisations with a greater understanding of the factors that influence health promotion activity within local government on the northwest coast of Tasmania. Survey, interviews/focus group discussions were used for collecting information pertaining to the capacity and attitude of the nine participating municipal councils to the delivery of health promotion activities within their respective communities. The follow up survey questionnaire, modelled on the initial Heart Foundation Survey sought, responses specific to health promotion initiatives and associated processes within their municipal council or organisation. A total of 33 participants were either interviewed (n=18) or participated in a focus group (n=15). Results from the evaluative study pointed to some key findings such as a strong preference by participating councils to maintain their current level of commitment to health promotion. Most of the survey respondents rated their council’s health promotion initiatives as effective. While an emphasis was found to be placed on initiatives to promote physical activities, moderate attention was paid to healthy food and other health promotion initiatives such as quit smoking programs. The evaluation also revealed that there was a lack of council policy to orient and guide current health promotion activity within their local communities. Generally, the findings from the survey were consistent with findings from 2011 Heart Foundation survey. Specifically, the main findings of the evaluation study are as follows: The stakeholders had a very clear perception of health promotion and how to translate the underpinning theory driving health promotion into specific on ground actions. § Health promotion could be manifested in a number of ways such as awareness raising, providing access to information and services, or providing means and skills so that the community is actively engaged in managing their health. § The majority of the respondents indicated that their council had a specific non-HCI funded (60%) and HCI funded (62%) health promotion program currently in place. 4 respondents (31%) reported that their council had recently completed a specific HCI funded health promotion program. § Nearly 40% of the respondents indicated that their council had currently in place governance structures such as a general council committee (or similar) to oversee and coordinate health promotion initiatives within the council area; § Just over half of the respondents (55%) said that their Council’s Strategic Plan currently includes health promotion objectives, with one council indicating that this was being developed. § Responses to the provision of physical activity initiatives were quite positive. The large majority of the respondents indicated that their council currently had programs and events that encourage participation in physical activity in place. § Similarly, the large majority of the respondents indicated that their council currently had in place sport, recreation, and active transport infrastructure to support physical activity. § Around half of the respondents indicated that their council had in place a dedicated budget/resource allocation to support initiatives that promote physical activity (46%). § Less positive was the response about planning and design initiatives or schemes that support physical activity. The evaluation revealed that there were a lesser number of participating councils involved with promoting and coordinating initiatives to support healthy and safe food, compared to the number of councils involved in promoting and coordinating physical activities. § Similar to the initiatives to promote healthy and safe food, other health promotion initiatives were indicated to receive moderate attention from participating councils. § Regarding future priorities, the respondents indicated a preference for putting a focus on "other" health promotion initiatives rather than physical and healthy food activities. § None of the respondents indicated their council had any intention to increase or decrease commitment towards health promotion. Meanwhile, nearly three fourths of all respondents (69.2%) stated that their councils would maintain current level of commitment to health promotion. § With regard to the level of formality associated with councils’ health promotion agenda 61.5%of respondents indicated that there were specific written objectives for all of the health promotion initiatives conducted by their council. The remaining respondents indicated either some (30.8%) or none (7.7%) of the council’s health promotion initiatives had specific written objectives. § With regard to feedback on community involvement and collaboration with other organisations around health promotion, the response was generally positive, with the large majority of the respondents rating community involvement (91%) and collaboration (83%) as either good or very good. § Program coordination of council and training/guidance provided by council was considered to be either satisfactory (50%), good (8%), or very good (33%) by the respondents. § Respondents showed a strong appreciation for the value and application of some of the other outputs from the HCI such as the HCI Toolkit. However, there was no specific comment relating to the use and application of QIPPS when referencing monitoring and evaluation systems § Comments from the interview/focus group participants on the HCI program outputs were generally positive. Of particular note was the acknowledgement and appreciation of the value of the HCI toolkit; confidence in partnerships among the nine local councils; and a greater sense of the increased capabilities of local government in delivering health promotion activities. § Regarding the general effectiveness of health promotion initiatives, 61.5% of the respondents rated their council’s health promotion initiatives as effective with the remaining respondents (38.5%) rating them as just right. This is a relatively positive evaluation. § Critical success factors relating to the delivery of health promotion initiatives by councils that were most often mentioned by the survey respondents were listed as follows (in order of frequency): participation/engagement of the target groups; sufficient funding; support from the community and local councils; active and engaging facilitators; and collaboration with other stakeholders/partners. § Similarly, the interview and focus group data was focused around the following success factors: engagement of the target groups; support from community and local councils; opportunities for building community capacity; consistency and appropriateness of the program; and promotion of the health promotion initiatives by local media. § Accordingly, the most common barriers to the successful delivery of health promotion initiatives by councils as mentioned by the survey participants was as follows (in the following order of frequency): Lack of funding, and resources (n = 11); lack of time and staff (n = 9); lack of engagement from the target group (n = 4). § Responses from the interviews and focused groups highlighted similar issues around limited funding and the risk of not being re-funded; lack of resources, including infrastructure and staff; the challenge in engaging the target groups; and the arduous reporting requirements. § With regard to what the respondents considered as important in ensuring the successful delivery of health promotion initiatives the responses were closely related to the identified success factors and barriers, including: eEnsuring sustainability; building better partnerships with local governments, NGOs and service agencies; developing appropriate methods in engaging the target groups; § The survey respondents strongly agreed or agreed with the following statements relating to council’s role and health promotion: Councils role is one that is associated with the provision of linkages/networks for the implementation of initiatives (100%); the provision of advice to other organisations involved with the delivery of health promotion initiatives (82%); the provision of environments which support healthy lifestyles for the community (82); the development and implementation of health promotion initiatives for its local community(82%); and the identification of community needs regarding healthier lifestyles (91%). § Most respondents (64%) agreed or strongly agreed that health promotion is a core council business. § A significant majority of the respondents believed that the three tiers of government should play a lead role in matters pertaining to the planning, infrastructure and resourcing of health promotion initiatives. A preference was shown for the role of local government over State and Federal government in relation to leadership of these aspects of delivering health promotion initiatives. § Regarding the programs and events that encourage participation in physical activity, most respondents considered local council (26%) or NGOs (26%) as having the lead responsibility. § The respondents saw local council or state/federal government as having the lead responsibility into planning, infrastructure, and resources.Regarding the delivery of programs and events that provide or support healthy food options, most respondents considered local council (30%), state/federal government (23%) or NGOs (23%) as having the lead responsibility. The following recommendations are put forward in relation to the delivery of health promotion initiatives, physical activity initiatives, healthy and safe food initiatives, and other health promotion initiatives: § Attention is paid to the integration of health promotion strategies into the policy of all local government to ensure consistency in commitment. § Capacity building through partnerships and collaborations with other service providers and community partners is a key success factor in the delivery of health promotion initiatives. Structures and models that support the sharing of skills and knowledge between participating agencies should be incorporated in future programs. § Provision of training and knowledge/skills generation should be regarded as part of, not separate to, the overarching objectives of the health promotion intervention § Consideration should be given to how council resources, including finance, infrastructure, and human, can be utilised in the support of health promotion initiatives. Policies that help ensure the stability of staff/positions in lead agencies eg local councils, service providers etc will help contribute to the sustainability of health promotion initiatives. § Processes that facilitate access to funding for community based health promotion funding initiatives should be supported as this funding is important in maintaining local momentum for health promotion efforts and can act as a lever for attracting new sources of funding. § Sustainability is a critical element, which should be built on the basis of empowering the community, building capacity for the community, or building on available skills or resources in the community. § Given the differential in local councils capacity to support health promotion initiatives consideration should be given to adopting program delivery models based on sharing or pooling of resources towards a common objective. § In addition to the focus on physical activities, local government should take a more active role in driving their community towards healthier and safer food by working with state/federal government and NGOs in enhancing availability, access and consumption. § The findings indicated that health promotion initiatives had been generally well oriented, coordinated, and monitored. This model is an example of good practice that should be further considered for application in future community based health promotion initiatives. § Consideration for the socio-economic and cultural landscapes of the target communities be taken into account to ensure the appropriate allocation of resources. § It is recommended that initiatives that facilitated improved access in terms of physical and financial access be developed to target the socio-economically disadvantaged groups. § As proposed by the program logic framework, there is a logical connection between program elements (inputs, activities, and outputs) and desired outcomes. It is suggested that similar framework and evaluation, both qualitatively and quantitatively, be carried out in a systematic way to produce more reliable and robust evaluative evidence.

Item Type:	Contract Report
Keywords:	Health promotion initiative, physical activities, healthy food
Research Division:	Health Sciences
Research Group:	Public health
Research Field:	Health promotion
Objective Division:	Health
Objective Group:	Public health (excl. specific population health)
Objective Field:	Public health (excl. specific population health) not elsewhere classified
UTAS Author:	Auckland, SRJ (Mr Stuart Auckland)
UTAS Author:	Le, Q (Dr Quynh Le)
UTAS Author:	Nguyen, HB (Dr Hoang Nguyen)
ID Code:	86157
Year Published:	2013
Deposited By:	UTAS Centre for Rural Health
Deposited On:	2013-08-27
Last Modified:	2014-03-20
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