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Title: Practicalities of public health practice and evaluation : the case of mental wellbeing in Coventry
Author: Johnson, Rebecca E.
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2013
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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.
Supervisor: Not available Sponsor: Coventry City Council; NHS Public Health
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA0421 Public health. Hygiene. Preventive Medicine