Health promotion planning and evaluation in public health units in New Zealand

Abstract

An ageing population, increasing rates of chronic disease, along with growing inequities in health status, and rising costs in health care and treatments are all placing a strain on the New Zealand health system. Combine these attendant issues with a work environment marked by funding constraints, prioritisation and high performance values, and the demands on health promoters to demonstrate evidence of effectiveness in planning and evaluation soon becomes evident.

This thesis explored the overarching question, ‘How do health promoters in public health units in New Zealand plan and evaluate their programmes?’ The study objectives were to understand best practice health promotion programme planning and evaluation, identify current health promotion programme planning and evaluation practice in public health units in New Zealand and finally, recommend improvements for health promotion planning and evaluation in public health units. I conducted semi- structured interviews with 17 health promoters (health promotion managers N=9; senior health promoters N=8) located in 10 of the country’s public health units. Interviews were thematically analysed using Braun and Clarke’s (2006) six-phase method.

My literature review supported the standpoint that no singular exemplar of best practice health promotion planning or evaluation can exist because of the context-dependent and multi-strategy nature of health promotion. Instead, a best practice approach that espouses a variety of principled and evidence informed approaches as they apply to different settings, circumstances, issues and populations is proposed. Interviews revealed that health promoters considered intersectoral action, collaborative partnerships and community engagement as important components of planning, with many reporting promising and effective examples of these in practice. Health promoters acknowledged that the practicality of incorporating these principles into practice was not without challenge. Participants were less confident discussing evaluation than they were planning and cited various barriers to conducting evaluation as these included financial constraints, short-term planning cycles, varying access to expertise, staff capacity, and the challenges entailed in evaluating complex programmes. Accordingly, a number of health promoters expressed a desire for operational and organisational support to strengthen evaluation capacity. There was a tacit expectation that Māori health promoters would act as cultural competency advisors and facilitate connections and networks in the community, adding another layer to their day-to-day responsibilities. Finally, the public health unit setting was perceived to facilitate as well as act as a barrier to health promoters’ ability to plan and evaluate.

Health promotion has an important role to play in reducing the burden of chronic disease and inequities in health status and access to health care. This thesis aimed to capture a snapshot of planning and evaluation practice in public health units in New Zealand and highlight the ever-present pressure on health promotion to demonstrate evidence of its effectiveness and strengthen its position in politically and socio-economically challenging times.