Have a Heart Paisley phase 2 Evaluation Key Findings by nyut545e2

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									Have a Heart Paisley phase 2
  Evaluation Key Findings
                 Emma Halliday*
 Policy evaluation and appraisal team, NHSHS

 Meeting of Anticipatory Care Practitioners
                  Network
       Dundee, 18th November 2008

 *Presented on behalf of external evaluation team
     Overview of presentation

• Reporting evaluation findings on behalf of external
  evaluation team at University of Edinburgh (led by
  Dr Sanjeev Sridharan)

• Overview of HaHP and evaluation methods and
  findings

• Will focus on some key findings from primary
  prevention
      About ‘Have a Heart Paisley’
• Have a Heart Paisley established in 2000 as 1 of 4
  national demonstration projects. HaHP was NDP for
  heart health

• Phase two launched 2005 and ended in March 2008

• HaHP delivered a targeted programme for the working
  age population (aged 45-60), and for those with existing
  heart disease, in Paisley
      Dimensions of HAHP phase two
Primary prevention targeted those aged 45-60 years old through
                   delivery of a tailored primary prevention
                   system. The overall aim of this dimension was
                   to reduce the targeted population’s risk of CVD
Secondary           targeted Paisley residents of any age who
prevention          already had been identified with CHD, but
                    whose condition was stable enough to be
                    managed in the primary care setting
Cardiac rehab.      focused on the development and integration of
                    community based phase III cardiac
                    rehabilitation and risk factor modification.
 About the external evaluation
• Independent evaluation of phase one conducted by
  University of Glasgow (March 2001 to March 2004)

• Edinburgh University commissioned to undertake
  phase two external evaluation (2006-2008)

• Worked collaboratively with internal evaluator at
  HaHP
  What was primary prevention?




Source: Sridharan et al (August 2008) Independent evaluation of HaHP phase 2
     What did we want to learn from
         evaluation of Primary
              Prevention?
1.Effectiveness study   Was primary prevention effective?


2. Process study        What is the intervention? Why is it likely to
                        work? What were the challenges?
3. Inequality study     Is the intervention likely to impact
                        inequalities
                        Were the ‘poor’ more likely to drop out
4. Barrier study        Challenges reported by programme
                        participants
                       Methods
• Interviews / focus groups with HaHP programme staff

• Detailed data from programme recipients to follow
  individuals over multiple stages of ‘primary prevention’:
   –   Participant behaviours and experiences (measures)
   –   Telephone interviews with a large sample of clients
   –   Personal interviews for a small sample of clients
   –   Detailed information on risk factors and risk of CHD
1. Was primary prevention effective?

 • Evidence of a favourable impact of the primary
   prevention on programme participants for a number
   of health measures, including risks of CHD

 • Impact especially pronounced when the risk
   associated with age removed from the risk scores
     Client reported outcomes &
             experiences
• Participants self reported many positive changes
  and experiences of health coaching, e.g.
   o increased confidence / awareness of health issues
   o more likely to use services and to have made changes
     to diet and levels of physical activity
   o Some evidence of influence on family and peers


• Most felt advice / support from coaches had more
  influence than screening information only
So that first meeting, „I cannae be bothered with this‟,
  do you know what I mean? And then we did and I'm
  glad we did. PP03

I'm very pleased. I'm still a wee bit numb and shocked
   eh, that I've went eight months now without the
   dreaded weed........I'm delighted with it because I
   could never see myself after so many years in this
   lifestyle of smoking, I was resigned to just being
   that‟s me for the rest of my life sort of thing you know.
   PP01
        2. What was learnt from
         implementing HaHP?
• Using risk score in implementing interventions
• High client volume was at times a major challenge
• Lack of technical and systems expertise
• HaHP described as too ‘internally’ contained
• Lack of an adequate exit strategy
   3. Addressing inequalities

• Inverse Care Law
“The availability of good medical care tends to vary
  inversely with the need for the population served”
Dr Julian Tudor Hart, The Lancet February 1971

• Interventions like HaHP and KW are an attempt to try
  and address the inverse care law
Standardised Mortality Ratios, all ages, from CHD, persons in
       Scotland by deprivation decile (Scotland=100)
                       Source GROS
3. Did HaHP impact on inequalities?

• Engagement with the programme inversely related to
  individual level deprivation (i.e., lower levels of engagement
  were associated with increased individual level deprivation)


• Men less likely to engage than women. Older people in
  target group (within 45-60 yr) more likely to engage


• Need for clear framework for addressing inequalities
Percentage of HaHP Sample
Living in Council Tax Band A
and B (%). Source: Sridharan et
al (August 2008)
     4. What barriers did clients
              report?
(Important limitation is that we know little about the
   views of those not responding to HaHP)

•   Competing priorities (family and work)
•   Lack of motivation to change or confidence
•   Poor perception of own quality of life
•   Scepticism of intervention
•   Availability of classes locally / costs
•   Physical limitations (health/mobility/aging)
• e.g. family responsibilities
It‟s finding the time too, you have the time to make the
    time to do the exercise and there's always something
    else to be done which is, there's always ironing or
    gardening. PP02

• e.g. lack of motivation
She phoned me up and eh said you know would you
  like to come and meet me, at that point I just wasn‟t
  in the mood for doing any health coaching or
  anything like that I just wanted to like get on. PP07
                        Summary
• Successful in aiding people to make changes that decreased risk

• Perhaps more likely to work for motivated individuals who want to
  change but need encouragement and ‘knowhow’ to follow
  through

• Very limited evidence that HaHP impacted health inequalities

• Need for flexibility that addresses heterogeneity of population /
  developing networks of support agencies

• Relevance of risk scores in capturing short term changes

• Organisational level issues (e.g. staff turnover, adaptability)
         Further Information
      HaHP & Keep Well external evaluations
       Emma.Halliday@health.scot.nhs.uk

    Anticipatory Care Dissemination Programme
          Theresa.King@health.scot.nhs.uk

 HaHP External Evaluation Reports and Summaries
www.healthscotland.com/evaluation-have-a-heart.aspx

								
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