Over 20 research and evaluation projects were undertaken in 2018. These included a mix of short-term projects completed in one calendar year and longer-term projects extending in part throughout 2018. A summary of each project’s activities and achievements is provided below.
2018 research projects
- Aboriginal Community Controlled Health Organisations evaluation project
- Addressing the needs of people experiencing prolonged grief (Phase 2)
- Audit of NSW SNAP SAS code
- Casemix Capacity Development: Phases 2 and 3
- Centre of Research Excellence in End of Life Care
- C-CHANGE: Delivering quality and cost-effective care across the range of complexity for those with advanced conditions in the last year of life
- Evaluating the impact of Intergenerational Playgroups in residential aged care
- Evaluation of SSI’s Humanitarian Settlement Service and service delivery model
- Evaluation of the LikeMind Pilot
- Evidence check: Collection of data to identify people with a disability accessing health services
- Men's Sheds
- Patient reported outcomes measures: stakeholder interviews
- Post School Programs
- Tackling Indigenous Smoking
- Tackling Indigenous Smoking Innovation Grant - Waminda
COORDINARE, South Eastern NSW Primary Health Network
Duration: January 2017 – June 2018
This project involves close collaboration with four Aboriginal Community Controlled Health Organisations (ACCHOs) in South Eastern NSW regarding the development and implementation of a community-based participatory evaluation and research program, which will help to enhance the research and evaluation capacity of the participating organisations. AHSRI’s Indigenous health research team are the conduit between the community, COORDINARE and AHSRI, to work alongside the services to develop research and evaluation projects that are of need and benefit to the Aboriginal community. The outcome of the project is to develop a framework of ‘doing’ evaluation and research ‘with’ ACCHOs. We are working with the ACCHOs to acknowledge current capacity and enhance skills through a strengths-based model. This works well as the skill sets within Aboriginal communities are often overlooked, however provide a base for developing skills further. The project consists of a number of elements, including: scoping review of the literature; development of a community-based participatory research model; development of a capacity building program designed with ACCHOs from initial needs analysis; knowledge translation and impact assessment. Ethical approval from the NSW Aboriginal Health and Medical Research Council and University of Wollongong has been received.
What we did
The design, delivery and evaluation of a workshop series has been implemented to assist with ACCHO staff skill development in evaluation and research. These workshops have included topics on research and evaluation, ethics, yarning as a method of clinical practice, logic models, evaluation frameworks, different types of data and a writing workshop. These workshops have been delivered at the University of Wollongong Shoalhaven campus.
The scoping review, ‘Development of an Indigenous perspective in Western logic models’, has uncovered the limited available published academic and practice literature that provides evidence of logic models that incorporate cultural elements from an Indigenous lens or perspective. The project continues to work in a culturally focused manner to assist with the development of an Indigenous specific logic model that captures cultural capital and self-determination principles.
We are currently working towards developing a manual for ACCHOs that will include information contained in the workshops in addition to very practical tools such as logic model templates and evaluation frameworks that can be utilised within the services and possibly other ACCHOs.
Funder: Australia Government Department of Health
Duration: June 2017 - March 2018
The objective of this project was to undertake a second phase of research on issues relating to bereavement and prolonged grief (formerly referred to as complicated grief), arising from the death of a significant person in someone’s life. This will assist the Palliative Care Section to address several short-term recommendations arising from the Phase 1 research project.
Further details about the Phase 1 research project are available to view. In addition, the Phase 1 final report is available to download (pdf).
Three sub-projects were undertaken concurrently as Phase 2 of this project:
- Disseminating findings/knowledge translation about prolonged grief for primary care, aged care and palliative care sectors.
- Supporting patient access to bereavement support and/or prolonged grief services through primary care and palliative care services.
- Identifying effective bereavement support strategies for carers engaged with palliative care services.
What we did
A suite of deliverables were completed during the year as part of the program of research into services and needs for people experiencing bereavement and prolonged grief.
For sub-project 1, a downloadable issues brief was produced for Primary Health Networks (pdf) and a webinar was conducted by the CHSD project team. Headline findings were presented to representatives of Primary Health Networks across Australia and an opportunity for questions from participants was provided. In addition, a second downloadable issues brief for residential aged care (pdf) was developed, based on a number of semi-structured interviews with large residential aged care providers in both the not-for-profit and for-profit sector and with peak organisations of key provider groups about their perceived need for information on bereavement support and prolonged grief in the residential aged care sector.
For sub-project 2, a report on pathways of bereavement support in palliative care was produced. The report was primarily informed by a cross-sectional national survey assessing the current state of bereavement support provision and related factors within Australian palliative care services. The survey was completed by 180 services (84% response rate). Data were analysed at the metropolitan and regional / remote level and used to develop three case studies (supplemented by a small number of in-depth semi-structured interviews with representatives of palliative care services, Primary Health Networks and Local Health Districts in metropolitan, regional and remote geographic areas across Australia). A workshop was also held with a small group of experts in bereavement support from the palliative care and primary care sectors which provided an opportunity to test assumptions underpinning data analysis and to explore perceived service gaps and corresponding policy implications.
For sub-project 3, an downloadable issues brief exploring stakeholder views and evidence relating to bereavement support for carers (pdf) was completed. The brief was based on semi-structured interviews with representatives of peak carer organisations, conducted to collect information on current bereavement pathways and services for carers and to identify unmet needs and service gaps. Additionally, a targeted review of the intervention literature was completed to further investigate effective ways to support carers prior to, during and after bereavement.
In early 2018 the overall results were presented to representatives of the Australian Government, with emerging policy and program implications discussed with key Departmental officers from the Palliative Care Section of the Department of Health.
Thompson C, Morris D and Williams K (2017) Bereavement support and prolonged grief: Issues for residential aged care (Issues Brief). Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.
Williams K, Morris D and Thompson C (2017) Issues Paper: Stakeholder views and evidence relating to bereavement support for carers. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.
Williams K, Thompson C and Morris D (2017) Prolonged grief: Applying the evidence in the primary care setting - Issues Brief for Primary Health Networks. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.
View a webinar with Primary Health Networks (mp4) was conducted on 31 October 2017, with headline findings presented to PHN representatives.
Project team: Cristina Thompson, Kate Williams, Conrad Kobel and Darcy Morris
Duration: June 2017 – June 2018
As part of NSW Health’s implementation of automated processing in various health information systems for their Activity Based Management (ABM) portal, a number of issues with the ‘business-as-usual’ code were identified through internal review processes, leading to a new development called the ‘Rewrite’ code.
CHSD, being the authors of AN-SNAP and the grouping software used by ABM, were approached to carry out an audit of the business rules documentation and SAS code which comprises the ‘Rewrite’ code. The goal of the audit was to verify for ABM that the SAS code correctly implements current business rules. A secondary goal of the audit was to verify that the business rules document would be a useful resource for any staff involved in the management of the SAS code or SNAP more generally.
What we did
This review involved two CHSD staff reviewing the business rules document collaboratively. One staff member conducted a detailed parallel review of the SAS code and source of truth document. The review of the business rules document was undertaken to verify that information in the document was internally consistent, consistent with the provided SAS code, compliant with the rules of the AN-SNAP classification, and to verify to ABM that the business rules as described would result in correct data being delivered to and output from the AN-SNAP grouper. The review of the SAS code was undertaken to verify that the SAS code correctly implemented the business rules as described in the business rules document and to identify any issues in the SAS code.
An interim report was produced in September 2017 containing the findings of the review and recommendations regarding changes to the structure and nature of the documentation and code. Following NSW Health’s consideration of the findings and implementation of changes where appropriate, CHSD undertook a final review.
Project team: Conrad Kobel and Dave Webster
Silver Chain Health
Duration: April 2017 – December 2018
Silver Chain established a research partnership with the NCCC to develop the organisational capacity and systems that were required to support a casemix-based approach to management. This was in response to changing external demands and increasing competition in the community health and aged care services sector. The program of work was limited in scope to the Silver Chain Health Division and was planned across three phases.
- Phase 1 was completed in 2016 and involved a gap analysis that established that the organisation’s information systems were adequate to provide the building blocks for a casemix-based system.
- Phase 2 included two key technical pieces of work; an activity-based costing study, which was completed in 2017, and the development of a classification for community-based care which was planned for 2018.
- Phase 3 activities involved knowledge transfer to key staff and the provision of a final report including recommendations for the implementation, application and refinement of the casemix system.
What we did
The development of the Silver Chain Community Care Classification during 2018 was a major deliverable of the project. Decisions around the selection of the classes that should form the classification were made in consultation with a clinical advisory group that had been established for the project. The classification was complemented by a minimum dataset and recommended set of business rules to enable the prospective collection of the data variables required for casemix analytics.
The major report delivered in Phase 3 presented a detailed set of recommendations for the establishment and ongoing development of the casemix system. These included recommendations around organisational level changes, particularly in the areas of information system development and governance, and also technical recommendations, including the role of casemix reporting systems and the provision of some sample casemix reports. The recommendations were the result of ongoing consultation and collaboration with a number of key staff and stakeholder advisory groups over the period of the project, as well as extensive technical work using the Silver Chain data. Strategies around capacity building and change management were also provided, as it was recognised that the introduction of the casemix system would have a wide reaching impact across the organisation and represented a major change in the way that the organisation would collect and use information.
The skills development process was also supported through a casemix analytics workshop presented to those staff that would be key in the effective use and maintenance of the system. The two day program explored how to use casemix reporting to assess clinical models and outcomes, financial efficiency, and performance against service agreements. At the completion of the project the four major reports that had been delivered throughout the research partnership were modified into an integrated suite of reports, to produce a comprehensive resource for the ongoing development of casemix-based management within Silver Chain.
National Health and Medical Research Council
Duration: October 2013 – September 2018
AHSRI was one of the collaborating partners in the Centre for Research Excellence in End of Life Care (CRE-ELC). The Centre brought together Australia’s leading researchers investigating end of life care issues and supported researchers to leverage their extensive clinical, community and policy networks to ensure that new knowledge could be translated for use. The Chief Investigators were based at Queensland University of Technology, The University of Queensland, Flinders University and the University of Wollongong. Under the academic leadership of Professor Patsy Yates, the funding from the NHMRC allowed the CRE-ELC to support a group of excellent researchers and students as they developed their skills and careers to become independent researchers, building capacity in Australia’s health research community.
The Centre formalised strategic linkages with leading researchers with expertise in chronic conditions (such as dementia, cardiovascular and renal disease), legal and ethical issues, social sciences and health economics. The CRE-ELC focused on generating the evidence required to ensure end-of-life services are responsive to the complex, unpredictable and often extended patterns of disease progression.
What we did
The CRE-ELC conducted a number of innovative research projects, for example an evaluation of the use of digital health and technological capability in palliative care and an innovative ‘design thinking’ workshop was developed and conducted focused on transforming end of life care in primary care.
Researchers from the CRE also utilised data from PCOC’s national longitudinal database. The aim of the research was to add to the evidence base needed to design effective service models, by examining the relationship between patient outcomes and a range of service (service location, models of care) and patient characteristics (demographics; clinical factors; carer support).
National Institute of Health Research
Duration: July 2013 – May 2018
AHSRI collaborated in C-CHANGE, a project led by Professor Fliss Murtagh from King’s College London. Working with leading palliative care researchers and clinicians from two English universities and two NHS Trusts, the long-term aims of the C-CHANGE project were to develop and validate a patient-centred, nationally applicable casemix classification for adult palliative care provision. This classification will reliably reflect the complex needs and concerns of patients and families, in order to enable the delivery of better quality and more efficient care in the last year of life.
What we did
This programme of research ensured that patients across a range of advanced conditions and settings can better receive the appropriate resources according to their individual needs. The C-CHANGE project was completed in 2018.
Funding: Liveable Communities Grant (Department of Aging, NSW Government)
Duration: January 2017 – January 2018
Playgroups are informal sessions where mums, dads, grandparents, caregivers, children and babies can meet together in a relaxed environment to promote fun, learning and friendship. Intergenerational playgroups, a relatively newer form of playgroup, have been designed with the additional aim of promoting intergenerational social interaction, learning and social inclusion. They are usually attended by three generations (elders, parents and children), and have been found to promote increases in happiness, dignity and self-esteem for older participants, as well as more active participation and sense of social connectedness in the community.
The key steps to successful implementation of a community led model within residential aged care environments are not well understood. The aim of the project was to develop and a test a best practice model for community led Intergenerational Playgroups (IPGs) within aged care settings, with Playgroup NSW, and three residential aged care services (two residential and one community centre).
What we did
A model for community led IPGs was developed, informed by Playgroup NSW’s community led models for parents and preschool aged children, and a literature review regarding intergenerational playgroups models and evaluation strategies. Existing playgroups within each of the target regions were then recruited with volunteer parents from these playgroups receiving training, resources, monitoring and assistance from a staff member employed by Playgroup NSW who had expertise in playgroup modelling and community engagement. The Playgroup NSW staff member also worked with a staff member from each of the aged care facilities to ensure the group activities and environment would meet the needs of both the children and the older participants. Three IPGs were successfully run and included in the evaluation.
Evaluation utilised a mixed methods design, including surveys and structured observation, to explore experiences and assess impacts associated with implementation of the community led model. The focus was on the experience of key stakeholder groups including parents and children, aged care staff, and aged care residents.
Evaluation results were overwhelmingly positive with regards to the IPGs supporting engaging and fun social interactions of mutual benefit for all the generations. The organised activities within the IPG were successful in promoting social contact and improved mood for the older residents. Structured observations and parent and staff report supported the activities as underpinning an uplift in mood within the aged care environments, and the increased alertness of many older people whether they were directly engaged with activities or not. Parent surveys also highlighted the interaction with older residents as a social asset for their children and themselves. The research also challenges the need for staff engagement and energy to drive cross generation interaction, gain meaningful input from older residents into program activities, and adapt aged care environments to meet the needs of younger children.
View a segment about this project aired by The Feed (SBS Viceland) on 3 October 2017.
Settlement Services International
Duration: July 2015 – December 2018
Settlement Services International (SSI) is one of the providers of the Humanitarian Settlement Services (HSS) program on behalf of the Department of Social Services. These services are typically provided to refugees and other humanitarian entrants in the first 6-12 months of settlement after arrival in Australia. SSI currently provides services to about 6,000 refugees and other humanitarian entrants annually in a decentralised model, with SSI’s HSS staff co-located in Migrant Resource Centres at nine locations across the Sydney metropolitan area. SSI wanted to know whether its decentralised service delivery model was more effective than other models in helping its clients achieve integration outcomes.
What we did
To compare the outcomes of SSI’s clients with other HSS providers’ clients, we surveyed a sample of SSI’s clients using questions selected from a broader national survey of humanitarian entrants, the Building a New Life in Australia survey. We also included questions from the Personal Well Being Index to make comparisons with the broader Australian community and questions about the experience of being a SSI client. We interviewed a number of key stakeholders from within SSI and from other humanitarian entrant service organisations to obtain their perspectives on the strengths and weaknesses of SSI’s service delivery model. We also conducted focus groups with a number of former clients.
As English literacy of clients was likely to be low, we used bilingual workers to contact SSI’s former clients. 401 clients were contacted. 210 telephone interviews were conducted (almost two thirds were conducted in languages other than English) and 26 paper surveys (22 in Arabic) were received. This provided a high response rate of 59%.
Overall, former HSS clients reported successful settlement, particularly where SSI had the most opportunity to influence outcomes, such as finding (and having high levels of satisfaction with) housing, getting children into school and child care, and knowing how to access essential services like the police. Compared with the Building a New Life in Australia comparison group, former HSS clients of SSI were more confident in essential tasks of daily life.
Summary of results
Download a summary of the evaluation results (pdf)
Project team: Peter Samsa, Kate Williams, Megan Blanchard and Dave Fildes
NSW Ministry of Health
Duration: February 2016 – December 2018
LikeMind is an initiative of the Mental Health, Drug and Alcohol Branch of the NSW Ministry of Health. The initiative’s service model can be characterised as a service-hub approach to the integrated provision of care and support for adults aged between 25 and 65 who experience mental illness.
The focus of the LikeMind service model is to provide proof of concept for a Non-Government Organisation (NGO)-led and managed model of integrated care for people with moderate to severe mental illness which is readily accessible in a community setting. It is assumed that co-locating mental health service providers in four community-based accessible premises with shared service protocols will lead to improved outcomes for consumers.
What we did
A mixed-methods longitudinal methodology was developed to address a specific set of evaluation questions. Data from multiple sources were collected to underpin the evaluation analysis. The evaluation team worked closely with the four LikeMind pilot sites to ensure that clinical and service utilisation data were available to inform both formative and summative evaluation findings. Stakeholder interviews and focus groups with consumers were held at three different timeframes at each of the four sites to gain an understanding of the different perceptions of the initiative.
The final report was delivered to the Ministry in December 2018 and included a series of recommendations to support the ongoing implementation of the LikeMind initiative.
Project team: Rob Gordon, Dave Fildes, Kate Williams and Conrad Kobel
NSW Ministry of Health
Duration: November 2017 – March 2018
NSW Health is committed to reducing discriminatory barriers for people with a disability. This may be facilitated by the development of a state-wide health system process for identifying people with a disability. However, as yet NSW Health does not have a state-wide process for identifying people with a disability in its health data systems.
The purpose of this evidence check was to ascertain whether other health jurisdictions in Australia and international health agencies/systems consistently identify people with a disability in their health system/service data collections. Evidence for the benefits/advantages of such data collections and implementation issues concerning the incorporation of such disability data items in NSW health datasets were also examined.
What we did
The research methodology for the evidence check was finalised in late 2017. The literature search was undertaken in early 2018 and showed emerging evidence within the international research, policy and practice literature to support the development and incorporation of disability identification processes within mainstream health systems and services as a way of addressing the health disparities faced by people with a disability.
As part of the evidence check, a number of standard disability data items were reviewed. From these, the Australian Institute of Health and Welfare (AIHW) Standardised Australian Disability Flag, combined with some additional items to identify type of disability, presence of other disability or comorbidity was recommended. This was presented as a potential starting point from which the NSW Ministry can work with key stakeholders to further refine and contemporise a suitable disability identifier for use within the broader NSW health system. Findings from this evidence check were presented at the ISOQOL 25th Annual Conference held in Dublin, Ireland, in October 2018.
Project team: Jan Sansoni, Pam Grootemaat, Anita Westera, Dave Fildes and Darcy Morris
Originating in Australia in the mid-1990s men’s sheds have provided a communal space for older men to meet, socialise, learn new skills, and take part in practical activities with other men. They have also engaged men in informal adult learning activities, provided health-related information and referred men onto relevant services to promote their health and well-being. There are approximately 1,000 men’s sheds operating in Australia with over 50,000 men attending on a regular basis. The movement is also spreading in the UK, New Zealand, and Ireland.
What we did
Healthy Cities Illawarra has been operating a men’s shed in Wollongong since 2005. The shed caters for four broad groups of men; a multicultural group, a Middle Eastern group, a homeless group and a refugee group. The goal of the shed is to build up and enhance the men’s sense of self-esteem and levels of social support, increase their sense of purpose and community connectedness, develop and refine their practical skills and to connect them into community projects and activities in which they can actively participate. CHSD developed an evaluation framework for the project leaders to use to enable them to gain an understanding of the participants’ experiences. The framework employs a modified Participatory Action Research (PAR) methodology and evaluation methods included: interviews (Baseline, mid-point and project end), coordinators diaries, discussion groups, men’s journals, photography, feedback sheets and evaluation ‘tokens’.
Evaluation results over the years have continued to demonstrate improvements in a variety of social determinants of health such as self-esteem and social connectedness. We have also been able to demonstrate a perceived improvement in the men’s overall health status. The men have also learned new skills, they have socialised with each other outside the organised group meetings and some have reported an improvement in their mental health status. The evaluation was also able to demonstrate a positive improvement in the measurement of the men’s community participation and capacity.
These results were published in the Journal of Men’s Health in 2010 and are available to view online in what we believe to be the first published research that attempts to measure health and well-being outcomes for culturally and linguistically diverse men involved in a men’s shed.
Waling A and Fildes D (2017) ‘Don't fix what ain't broke’: evaluating the effectiveness of a Men's Shed in inner-regional Australia. Health and Social Care in the Community, 25 (2): 758–768.
Fildes D, Cass Y, Wallner F and Owen A (2010) Shedding light on men: the Building Healthy Men Project. Journal of Men's Health, 7 (3): 233–240.
Project leader: Dave Fildes
Australian Commission on Safety and Quality in Health Care
Duration: May 2017 – June 2018
Patient reported outcome measures (PROMs) are tools used to understand health outcomes from the perspective of consumers. They are increasingly seen as an important source of information to guide quality and safety improvement in health care, in conjunction with the more traditional clinician-reported outcomes, measures of health care processes, and measures of output, such as the volume of procedures performed by a provider.
Since May 2016, the Australian Commission on Safety and Quality in Health Care (the Commission) has engaged CHSD in a program of research to examine how PROMs are being used in Australia and internationally, with a particular focus on the potential purpose and benefits of national-level collation or collection. This work has included an environmental scan of current activity and a review of the academic and practice literature, both of which have been published online. The third component, completed in 2017, was a series of interviews with representatives from all Australian jurisdictions and with Australian and international experts. The interviewees were asked about current activity in PROMs, lessons to be learned from existing initiatives, and desired future directions. Together, these three pieces of work provide a foundation for the specification of options for the extent and nature of the Commission’s future national leadership role in the area of PROMs.
What we did
The final phase of this work was designed to facilitate knowledge transfer into policy. Dr Kate Williams worked closely with the Commission to integrate the findings from the three reports into a set of options for a future national role in coordinating and promoting PROMs efforts in Australia. In collaboration with a Commission staff member, she created a Theory of Change for PROMs to guide the formulation of an evidence-based plan of action. Three potential roles were identified: leadership and advocacy; stakeholder engagement; and guidance and facilitation. These roles were considered and discussed by an Expert Advisory Group on PROMs with representatives from across Australia. The final Options Paper, incorporating feedback from the Expert Advisory Group, was submitted to the Commission’s Inter-jurisdictional Committee in June 2018.
Project team: Dr Kate Williams, Cristina Thompson
Each year since 2002, Ageing, Disability and Home Care (ADHC) in the NSW Department of Human Services has commissioned the Centre to work on the allocation of school leavers with disabilities to the post-school programs that they provide. The work supports the Department’s program planning and the allocation of places within different components of the post-school programs, in particular the Community Participation Program. Recommended allocations are based on assessment of the functional abilities of young people with disabilities. CHSD’s involvement in the process has developed into a continuous refinement of the tools and allocation of resources within the program on a State-wide basis.
The increasing acceptability of the approach in the sector and with the end users has been particularly satisfying for the Centre. Our work helps to match young people leaving school to the program that best matches their level of ability. It also provides a model for developing client classification and costing methods for use in disability services. This work has attracted interest from other States, mainly Victoria, where the Functional Assessment Tool (FAT) Pilot was conducted in 2009. The interest in the model is because it uses a consumer and not service-based focus and the results are derived from the cost of services actually provided to each client, not just based on the program’s historical funding allocation.
Underlying this work is the relationship between the functional independence of the young person and the level of support he or she requires. This relationship is explored in the journal article linked below:
Eagar K, Green J, Gordon R, Owen A, Masso M and Williams K (2006) Functional Assessment to Predict Capacity for Work in a Population of School Leavers with Disabilities. International Journal of Disability, Development and Education. 53 (3): 331-349.
View the 2015 manual:
Eagar K, Green J and Owen A (2015) The NSW Post School Programs Eligibility Assessment: a guide to functional assessments in 2015. Australian Health Services Research Institute, University of Wollongong.
Finalist in Premier’s Awards
This collaborative research project involving members of AHSRI’s Centre for Applied Statistics in Health (CASiH) was a finalist at the 2016 Premier’s Awards, presented on 25 October 2016. The project also involved staff from the NSW Department of Family and Community Services (FACS), NSW Department of Education and Catholic Education.
The collaborative post school programs assessment process is widely recognised as best practice and has now been trialled by the NDIA in Tasmania, Victoria and the ACT. This success combined with the excellent outcomes achieved through the NSW Transition to Work program has resulted in a new School Leaver Employment Support program under the NDIS.
Project staff were recognised for their work with helping people with disability transition to work.
AHSRI has been involved in the project since 2002, having developed the functional independence tool that is used by teachers to assess school leaver applicants, processing scores to provide a recommendation for program and funding level (where applicable) for each applicant and providing teacher training to ensure consistency in how the applicants are assessed.
Project team: Janette Green, Megan Blanchard
Grand Pacific Health
Duration: March 2016 – June 2018
Tobacco is the primary cause of preventable disease and early death in Aboriginal Australians, with one in five deaths related to direct or passive smoking. The Tackling Indigenous Smoking (TIS) initiative coordinated by Grand Pacific Health is part of the Australian Government Department of Health’s Tackling Indigenous Smoking Regional Tobacco Control Grants, aimed at improving the health of Aboriginal and Torres Strait Islander people through a variety of population health activities to reduce tobacco use. The initiative’s primary focus is on tobacco use outcomes. The initiative will deliver a population and preventative health approach directed to all Aboriginal and Torres Strait Islander people in the South Eastern NSW region, irrespective of what health provider the individual uses. The initiative is being undertaken in collaboration with, and to complement, NSW state tobacco control activities.
What we did
The main role of the CHSD was to develop and assist with the implementation of an evaluation framework and associated activities for the TIS initiative. Refinements to the CHSD evaluation framework were made to align with the TIS activities and program logic. Evaluation materials were designed and implemented, including forms and surveys for baseline and follow up evaluation activities. Data collection and analysis was also undertaken.
A framework which has been developed and used successfully many times by CHSD at AHSRI in the design of evaluations was used. For more information on the evaluation framework, see Masso M, Quinsey K and Fildes D (2017) Evolution of a multilevel framework for health program evaluation, Australian Health Review, 41 (3): 239-245.
Waminda South Coast Women’s Health & Welfare Aboriginal Corporation
Duration: January 2017 – June 2018
The Waminda South Coast Women’s Health & Welfare Aboriginal Corporation was funded by the Australian Government Department of Health Tackling Indigenous Smoking (TIS) Innovation Grants to deliver the Waminda’s Balaang and Binjilaang – South Coast NSW Aboriginal Women’s Tobacco Intervention Project. The Balaang and Binjilaang project has been designed to encourage and support Aboriginal women and young women to attend support groups, to reduce the psychological distress of tobacco intervention and reduce nicotine dependence while increasing quit attempts for participants within the project – while being delivered within a culturally safe framework. Professor Kathleen Clapham was commissioned to conduct an evaluation of Balaang and Binjilaang across the three implementation sites – Nowra, Wollongong and Bega. The research aims are to: assess the impact, both separately and together, of group attendance and reductions in psychological distress on tobacco use; assess the impact of the intervention on the intentions and confidence of Aboriginal women of child bearing age not to smoke when pregnant; identify core components of the intervention that contribute to its effectiveness; and assess the potential for scalability.
What we did
The project commenced in January 2017. Ethical approval was obtained from the UOW Human Research Ethics Committee and the Aboriginal Health and Medical Research Council (AHMRC). Program implementation has been staggered across five sites in the Illawarra (Coomaditchie), Shoalhaven (Nowra) and Far South Coast (Bega, Wallaga Lake and Eden) regions.
A program logic model was developed in the initial stages of the project. This involved the research team working closely with program staff to achieve a shared understanding of the underlying rationale or logic of the TIS program, and to illustrate how and why the program is expected to achieve its short, medium and long term outcomes. The evaluation framework developed includes details of data sources utilised for the evaluation. The evaluation is a mixed methods study that applies a variety of quantitative and qualitative data collection methods from multiple sources to provide a comprehensive analysis of the processes, outcomes and impacts of the program.
Qualitative and quantitative data collection is currently being completed across all sites. Program data is being collected on an ongoing basis for analysis. The process evaluation includes minutes of meetings, annual reports, and other available documentation. It includes the routinely collected program data for individual TIS clients. Additionally, the evaluation framework sets out a number of specific questions about how the program is being implemented at each of the sites. Qualitative data is being collected in two ways: yarning sessions and field observation. Yarning sessions are being used to explore and assess the individual client experience of the program (Bessarab and Ng’andu 2010). Field observation provides researchers with an opportunity to observe how the program works in its naturalistic setting at each site and to better understand the processes of program implementation and the interaction between clients, and clients and staff.
A preliminary analysis of the qualitative data obtained from the yarning circles has revealed the following themes: positive program delivery; impact on smoking behaviours; impact on wellbeing; health literacy; gender; and the importance of connections.
The research is being conducted within Waminda’s cyclical model of care. Capacity building for Aboriginal researchers and health workers is an important component of the research.