Background
There were concerns that robust evaluation of national public health programmes delivered locally was not being done, resulting in a lack of evidence to demonstrate the impact of programmes.
Methods
A qualitative field study drawing on ethnographic approaches was carried out over 18 months in a Public Health department in a UK Primary Care Trust. Interview and observation data from 16 participants of varying roles and experience involved in implementing the NHS Health Check programme including programme documentary data was analysed using the constant comparative method to understand how evaluation was perceived and conducted in practice.
Results
Participants' informal evaluation definitions encompassed different activities that formed an integral part of assessing the progress of the programme’s delivery and implementation. Formal evaluation was defined as the processes required to produce reports for official scrutiny, demonstrate compliance with official targets, and provide evidence that programmes are delivered. Organisational structures, resources and expectations were instrumental in determining how evaluation was conducted. Evaluation in practice was observed to be predominantly retrospective, unstructured and focused on generating descriptive information about the programme's processes and progress. Participants devised their own multi-purpose and diverse evaluation procedures to meet personal, professional and organisational obligations to demonstrate success in some form.
Conclusion
Limited use of recognised public health evaluation methodologies at local level was due to a mixture of operational, political and personal factors, including the desire to show success. The purpose of evaluation was to provide information to justify policy and financial decisions and to preserve services and jobs. Therefore the political and organisational structures and arrangements need to be in place to enable public health professionals to conduct robust evidence to deliver critical findings.
