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Practicalities of public health practice and evaluation : the case of mental wellbeing in Coventry
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Johnson, Rebecca E. (2013) Practicalities of public health practice and evaluation : the case of mental wellbeing in Coventry. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b2724929~S1
Abstract
There are gaps in the UK knowledge base for understanding the implementation
and evaluation of public health interventions which aim to improve the mental health
and wellbeing of participants. In this thesis I examine the measurement of mental
wellbeing and the implementation of health improvement interventions in a
community setting and investigate the practicalities of their evaluation using a
measure of mental wellbeing -- WEMWBS.
Methods: Using a mixed methods approach I collected and analysed i) three cross
sectional surveys of Coventry residents, ii) quasi-experimental before and after
outcome evaluations of three CHIP projects, and iii) undertook semi-structured
interviews with CHIP stakeholders. Data were integrated using a matrix technique.
Results: A total of 8188 individuals (~40% response rate) completed valid survey
questionnaires in 2010-2012, while 590 individuals (~88% response rate) completed
valid before-after mental wellbeing outcome evaluations in 2011 and 2012 from
three CHIP projects. Fifteen one-on-one interviews were completed. I found that
health and lifestyle variables ‘sleep quality’ ‘physical activity’ and ‘fruit and vegetable
consumption’ showed the strongest and most consistent patterns of association with
levels of mental wellbeing measured using WEMWBS. CHIP projects demonstrated
associations between the intervention and increases in mental wellbeing, some of
which were both statistically significant and clinically meaningful. Some were
sustained at three months.
Interview findings showed that the difference between the plans and the observed
implementation practices resulted in some of the projects struggling to cope with the
evolving and changing needs of the programme, for example moving from outputs
to outcomes, introducing mental wellbeing and changing concepts of health, and the
work required to achieve partnership with the local authority). The effect on
programme level outcomes and outcome measurement of these struggles was a
reduction in the number and quality of valid evaluation returns from some of the
projects in the programme and reduced staff capacity to deliver project objectives.
The introduction of mental wellbeing as an outcome measure created a momentum
of change for understanding complex health interventions and outcomes among
stakeholders; it assisted those delivering the CHIP programme to
understand the underlying health improvement rationale for their programme better.
Through integrating quantitative datasets I provided a benchmark from which to
make comparisons between population estimates of WEMWBS and observed
evaluation findings. Integrating quantitative evaluation process challenges and
qualitative insights from stakeholder interviews allowed for complex issues to be
‘untangled’. Interrelated mechanisms affected facilitators and barriers of programme
planning, implementation, evaluation and sustainability. Integrating my quantitative
and qualitative findings highlighted some clear health benefits from the projects but
also highlighted a lack of congruence between the documented linear,
unidirectional and unrealistic operational planning which I found in CHIP at a
programme level, compared to practical implementation on the ground, which was
nonlinear, complex and dynamic.
Conclusion: Iterative, transitional stages of programme development could benefit
implementation processes and potentially health outcomes, including mental
wellbeing, in future public health practice. Further research in this area should
explore the extent to which complex, collective, and adaptive operational planning
can result in more successful public health improvement programmes.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine | ||||
Library of Congress Subject Headings (LCSH): | Public health -- England -- Coventry, Public health -- Evaluation, Mental illness -- England -- Coventry -- Statistics, Mental health surveys -- Great Britain, Well-being | ||||
Official Date: | September 2013 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Clarke, Aileen; Stewart-Brown, Sarah | ||||
Sponsors: | Coventry City Council; NHS Public Health | ||||
Extent: | 1 volume (various pagings) : illustrations, charts. | ||||
Language: | eng |
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