Evaluation of Community Change through Family Planning Programs

In December 2011 the Tasmanian Community Fund (TCF) provided funding support to Family Planning Tasmania (FPT) to develop and run two community focused programs aimed at reducing unplanned teenage pregnancy. The two programs, one based in the Derwent Valley and the other in the North West region, centred around the city of Burnie and aimed to provide support services to teenagers, general practitioners and youth/ health workers by way of sexual health education, training and clinical services. The funding was provided in response to the comparatively higher rates of births amongst teenagers aged 15-19 in Tasmania. Whilst the teenage rates of pregnancy are falling in Tasmania, in 2000 the rate of births to teenagers 15-19 was 25.7 per 1000 women; this rate had fallen to 21.5 per 1000 women in 2010. Despite this decrease, the rate is well above the national teenage fertility rate of 15.5 births per 1,000 teenagers aged 15-19 (Australian Bureau of Statistics, 2010). Importantly, statistics on teenage birth rates show a variance in rates according to location and socio-economic disadvantage. The statistics show a clear gradation from urban areas, particularly affluent urban areas, to remote and regional areas, with the highest teenage birth rates, particularly in areas of high socio-economic disadvantage. The Derwent Valley region and North West coast are known to have some of the highest rates of teenage pregnancy within Tasmania. The issue of teenage pregnancy has been of considerable significance nationally and internationally because young maternal age is associated with adverse social, economic and health outcomes for both mothers and children (Swann, Bowe, McCormick, & Kosmin, 2003). According to Bishop (2006), teenage mothers can be more prone to a multitude of issues including negative public attitudes, social isolation, poverty and prolonged welfare dependency, decreased marital opportunities and greater exposure to physical abuse. The University Department of Rural Health (UDRH) at the University of Tasmania received funding through the Tasmanian Community Fund to undertake an evaluation of the two community focused programs. In particular, the evaluation was aimed at measuring the effectiveness of the funding in assisting the programs to effect change in the community towards a reduction in the incidence of unplanned teenage pregnancy in the short, medium and long term. The evaluation methodology was framed around best practice approaches for measuring the effectiveness of health-related intervention/educational programs. In particular, the methodology was based on process and outcome assessments. The evaluation considered; firstly, the management and delivery of the programs, and secondly, the programs' impact on awareness and attitudinal and behavioural changes among the target population. These were considered the major indicators of the programs’ effectiveness. Data from a number of different information sources was collected, including both primary (interviews, and focus group discussions/forums) and secondary sources (policy and program documents, reports, discussion papers, and relevant statistics available through aggregate databases). Overall findings from the assessments of program design, management, and delivery, as well as changes in awareness, attitudes and behaviours within the target community, suggested that the two programs were relatively well coordinated and, despite the relatively short delivery timeframe, had a positive impact on awareness, attitudes and behaviours within the target communities. Whilst there were differences in the strengths and weaknesses of the program between the two program sites which, in some cases, reflected the different socio and cultural environments, there were some positive attributes common to both sites. These included: • Flexibility in terms of program governance which facilitated input by local stakeholders in the shaping and refining of the programs; • The programs were well accepted and supported within both host communities; • The accessibility and adaptability of the programs to suit the needs of the local target population and community; • Adoption of a multi-dimensional approach to sexuality and sexuality education • The application of models of training that focus on strategies that are inclusive and contribute to the sustainability of program objectives such as the Families and Schools Together (FAST) model; and • The use of peer educators or role models in the delivery of educational activities. The programs experienced a number of challenges that tended to be site specific. These challenges were related to the establishment of appropriate local governance support structures which were in part hindered through staff changes at the earlier stages of the program initiative. There was also a general perception amongst some stakeholders that the program timelines were too short to affect any significant behavioural or attitudinal change within the two communities. There was also a sense that programs could have benefited from improved promotion of activities particularly to young males. The statistics relating to the participation of young females to males in program activities supported this notion. Key recommendations from the evaluation include: • A stronger emphasis on building sustainability into the program design on the basis of community involvement, community empowerment, community capacity building and the development of interpersonal and communication skills; • Greater involvement of young people in all phases of program planning and evaluation; • Application of models of promotion and delivery which equally target both young women and young men; • More direct engagement with local schools with a view to exploring ways in which programs may complement existing school sexual health programs • The adoption of more accurate and reliable measurements of community change and the instigation of repeated outcome evaluation studies, which should be carried out over a period after the programs closure; and • Further funding support for sexual health programs which are multi-dimensional, focusing on education, attitudes and behaviour.