Background:
Obesity is a public health challenge requiring sustained, multifaceted action to have a population impact. Health and Wellbeing Queensland (HWQld) is a new health promotion agency which seeks to influence the underlying structures and conditions related to inadequate diet, physical inactivity, and health inequities by adopting a systems-based approach. However, there are few, reported evaluation frameworks designed for capturing signals of systems change in public health prevention.
Methods:
A partnership between HWQld and the Institute for Social Science Research at The University of Queensland co-created a comprehensive Monitoring, Evaluation, and Learning Framework (the Framework) that captures signals of system changes that contribute to health outcomes at the population level. The Framework was informed by a literature review, developed by public health researchers and practitioners, and guided by a set of underpinning principles.
Results:
The Framework is centred around a high-level ‘Theory of Change’ that illustrates how HWQld’s actions will influence the systems associated with obesity and health inequity and contribute to population level outcomes and impacts. Four ‘Systems Components’ were identified to represent different parts of the system that HWQld aims to influence: Policies; Practices; Networks; and Mindsets. A ‘Ceiling of Accountability’ was introduced to distinguish between ‘performance accountability’ and ‘population accountability’ recognising that accountability for the higher-level population outcomes cannot be assigned solely to an organisation when addressing complex system changes. The Framework provides a pragmatic structure to operationalise the complexity of system changes into concepts that will allow for organisational strategic learning and planning, with better measures and understanding of HWQld’s roles in influencing the prevention system in Queensland.
Conclusion:
The Framework integrates knowledge and data generated by HWQld's actions to capture change, report outcomes, and use learnings to flexibly adapt the organisation’s efforts to improve health of Queenslanders.