Project: "Quali-Set-Praxis" - Practical Quality Assurance & Management in Health Promoting Settings

Project Head: Doris Hayn Project Partners: BIPS – Bremer Institut für Präventionsforschung und Sozialmedizin (Gesamtprojektleitung) Projekt Zwerchallee / Verein Armut und Gesundheit in Deutschland e.V.     Funding: Federal Ministry of Education and Research; own financial resources Duration: 09/06 – 08/09     Field of research Research Area: Everyday Life Ecology, Energy, Consumption   about the Institute

Development and Test Implementation of an Evaluation and Monitoring Matrix Pilot Setting: The Programme "Health Now in Social Flashpoints" for Health Promotion in the Homeless Settlement "Zwerchallee" Disease prevention and health promotion have become increasingly important to society during recent years. Numerous committed participants are striving to sustainably improve the population's health and quality of life through myriad innovative projects and programmes. High societal expectations for progress in achieving positive health related effects accompanied by simultaneous cost reductions in the health sector raise a crucial question: How can these programmes be put into practice most efficiently and effectively? This question provides the impetus for the research project. The project goal is to develop a practice-oriented set of measures that will ensure the quality of health promoting programmes and projects in the setting of a neighbourhood. Starting point of the project is the participative evaluation of the health promotion programme in the "Zwerchallee" settlement for homeless people. The objective is to develop and test for general application an evaluation and monitoring matrix focused on children and adolescents. Disease Prevention and Health Promotion in Science and Practice The population's health, quality of life, mobility and physical capabilities can be sustainably improved through developing and effectively applying specific measures of disease prevention and health promotion. As these measures are implemented and health improvements begin to accrue, a portion of present health expenditures, especially those for preventable diseases, will become unnecessary. With the recent health system reforms (Gesundheitsreform 2000), disease prevention and health promotion have explicitly become the tasks of health insurance organizations in Germany. This change has compelled strong upgrading of numerous preventive measures. Further, it is now envisaged to create a new law based on disease prevention, thus making it the fourth pillar of the German health system. At the same time, health promotion is seen as a societally essential field of research which requires the development of interdisciplinary practice-oriented research. Goals and Opportunities related to Disease Prevention and Health Promotion Interventions for primary disease prevention and health promotion focus on developing individual capabilities and on strengthening health promoting structures within specific social environments (Settings), the goal being to improve individual empowerment with regard to one's own health. Primary disease prevention and health promotion should assist individuals changing their health related behaviour and developing abilities to better cope with health risks and issues. Programmes and projects in this field have the potential to diminish health related social disparity by focussing on disadvantaged target groups such as children and adolescents and taking into consideration the social context of such groups. Especially for groups with elevated health risks and low social status, interventions directed at the individual (behavioural prevention) are often rather insufficient. What is required is a combination of individual interventions with interventions at the organizational or societal level in settings such as schools, workplaces, and neighbourhoods (systemic prevention). Quality Evaluation, Assurance & Management in Practice Numerous new approaches to disease prevention and health promotion have been recently developed and many participants are now working in related programmes and projects. High societal expectations of success in achieving positive health related effects while simultaneously reducing health sector costs raise the question of how the new approaches can be put into practice efficiently and effectively. For this reason, development of standards for quality evaluation and management concepts are required. Such standards must enable clear communication with respect to the understanding of quality and must establish a reliable basis for comparison among different interventions. Quality is a dynamic factor during the process of complex disease prevention and health promotion interventions. Adequate evaluation concepts therefore must allow for frequent monitoring, which not only documents the results of specific interventions but also tracks success in establishing self-supporting, i.e. sustainable structures. Moreover, agreement over the understanding of quality must occur both within the respective projects and programmes and within the larger framework of a structured quality management discourse among participations representing all relevant groups from politics, practical intervention and science. Such a long-term discourse is essential for achieving sufficient transparency and participation and to establish and sustain active public debate about health promotion. Development and Test Implementation of an Exemplar Evaluation and Monitoring Matrix The foregoing discussion provides the background for guiding the research project "Quali-Set-Praxis". The project will develop a practice-oriented set of quality management measures with respect to health promotion programmes and projects in the setting of a neighbourhood. The initial objective is to develop a communication and practice-oriented evaluation of the project "Health Promotion in the Homeless-Settlement ‘Zwerchallee'" in Mainz. The purpose of this model evaluation is to develop and implement an evaluation and monitoring matrix applicable to interventions within the setting of a neighbourhood in general and with particular focus on children and adolescents. The key criteria or backbone of the matrix are integration, participation, and communication. Within these key criteria, questions concerning the evaluation matrix can be developed and refined in accordance with each step of the process of project implementation (concept, structure, result, assessment). As a third evaluation dimension, the following cross section criteria will also be considered: aspects of social differentiation (gender, ethnic aspects, cultural aspects), participating groups (citizens, public and private cooperating partners, health promotion teams) along with general success criteria such as effectiveness, suitability, acceptance, efficiency and equality. The matrix to be developed will be applicable to evaluating projects in whole or in part (for example diet, movement, relaxation, environment, vaccination und health information). The Exemplar of the Settlement for the Homeless "Zwerchallee" By choosing the project "Zwerchallee," which focuses on health promoting interventions within a settlement of Homeless, the project concentrates on the primary area of disease prevention interest within health politics, namely the diminishment of health related social disparity. A powerful starting point is investigation of the link between child poverty and health, an issue which urgently needs to be dealt with by health politics. Furthermore by choosing to intervene in the setting of a neighbourhood a neglected area of evaluation is purposely approached. The goal is to develop and put into practice an effective evaluation and monitoring matrix that ensures quality management throughout the intervention process. Through this model development and testing of the matrix, the project will simultaneously provide an exemplar for good practice concerning systematic inclusion of gender and other factors of social differentiation. The results of the project should lead to a visible improvement in the scientific basis for setting-oriented disease prevention and health promotion related to socially underprivileged segments of the population, especially within the target groups of children and adolescents. Discourse on "Quality Management" The development and test implementation of the matrix is accompanied and monitored by an accompanying quality management discourse among relevant groups from politics, practical intervention and science. This discourse is intended to contribute to the quality infrastructure of health promotion and to initiate public discussion on related potentials and needs. The discourse on quality management combined with communication measures and incorporating the fundamental research principles of "participation" and "transparency" is designed to ensure broad acceptance and applicability of the evaluation and monitoring matrix.

2008-07-17