Learning from local communities: Prevention Tracker expands
Project title: Prevention Tracker: Describing, guiding and monitoring system change efforts in local communities
Start date: January 2016
Estimated end date: June 2018
Prevention Tracker is working with communities in Glenorchy, Tasmania, Albany, WA, Broken Hill, NSW and Gold Coast, Queensland. For more information, please click on the Community updates tab above.
What is the issue?
Chronic diseases are Australia’s greatest health challenge. Lifestyle factors such as smoking, harmful alcohol use, poor nutrition and physical inactivity are causing a massive increase in chronic diseases including cardiovascular disease, respiratory disease, cancer and diabetes. Almost half of all Australians have a chronic disease and these diseases lead to eight in 10 premature deaths.
It is becomingly increasingly clear that we need to change the way we think about prevention if we are to buck these trends. Systems thinking has been used to understand and manage complex problems at a local and global level. It’s both a way of thinking and a practical tool to help tackle complex problems. It helps us to see the big picture – how the problem we’re trying to solve is made up of connected and inter-related components, so that a change in one part will influence other parts.
In cities and towns all over Australia, many different organisations, people and programs work to reduce the risk of chronic disease for the people in their communities. This work is not just happening in the health sector – people and organisations in education, transport and local government among others all make contributions that can improve their communities’ health.
However, little is known about how these people, activities and networks interconnect to shape a local prevention system. Understanding these interconnections, using systems thinking tools and methods, may be the first step to the design of new ways to intervene for chronic disease prevention.
How is the project addressing the issue?
Prevention Tracker is a national project that is exploring how local communities work to prevent chronic disease. Expanding a pilot project in Glenorchy, Tasmania, Prevention Tracker is working with a number of communities across diverse areas and populations of the country to help us to better understand local communities’ prevention systems and then guide and monitor communities’ work to prevent chronic disease. We will gather and learn from this knowledge to build a comprehensive picture of an effective prevention system for Australia.
By prevention system, we mean the people, processes, activities, settings and structures – and the changing relationships between them – that work together to try to improve the health of a community (see diagram). The idea is that if we can better understand the parts of a prevention system, and how they connect to make the whole, we can make better decisions about where and how to intervene to bring about improvements.
Prevention Tracker will attempt to describe each of these system parts and their interconnections by testing a range of methods in real life community settings. We will look at four main areas to understand a community’s prevention system and identify ways to improve it.
Describing the local prevention system
We will work closely with local communities to describe and understand their local prevention system.
This work will include:
- An inventory of health and well-being programs, policies and regulations that have the potential to reach community residents
- An atlas that maps key indicators of the liveability of a community
- A snapshot of the community – their health status and health risks
- Key informant interviews about partnerships for prevention, the prevention workforce, and what is working well and not so well in terms of health and wellbeing efforts in the community
- An organisational network analysis to measure connections with other organisations working across the community to improve the health of the community
- Community workshops to identify the complex causes of chronic diseases and opportunities for community-led actions for change.
Guiding system change within the local prevention system
Once we have described the local prevention system and begin to understand why things are the way they are, the next question is where and how to intervene in the prevention system.
Like all systems, prevention systems are dynamic and constantly adapting to changing circumstances. As a result, ‘action learning’ is a key part of Prevention Tracker. This means working closely with a team of local stakeholders who have the capacity and authority to implement strategies and assess their impact. With this team we will identify where and how to intervene to bring about systems change.
Monitoring system change within the local prevention system
An important part of describing and guiding system change efforts is knowing whether these efforts are making a difference. We will work with local teams and stakeholders to identify indicators of impact and progress towards achieving shared goals that strengthen the local prevention system.
Describing the model of Prevention Tracker
Each Prevention Tracker community will provide an opportunity for us to compare and contrast to identify a suite of common methods and inquiry processes best able to describe, guide and monitor system change in local prevention systems.
Relevance for practice
This initiative will develop methods for identifying and measuring local prevention systems. It will provide data that will allow us to make comparisons over time, both within communities as well as across different communities.
Our vision is that using and comparing local community information will help to guide action at both local and national levels – actions such as better allocation of resources and stronger partnerships – to reduce the impact of chronic disease.
Ultimately, we will pool and use what we learn from local communities to inform what is needed at a state and national level for an effective, efficient and equitable system for the prevention of lifestyle-related chronic disease in Australia.
What are the expected outcomes?
Prevention Tracker is providing unique opportunities to work with a number of communities to identify a suite of methods and processes that other communities could use describe, guide and monitor their own efforts to prevent chronic disease.
The project is also generating rich information about the strengths and challenges of this type of model in local communities. We are committed to sharing our learning through publication, presentations and social media.
- Dr Dan Chamberlain, La Trobe University
- Dr Seanna Davidson, Prevention Centre
- Maria Gomez, Prevention Centre
- Dr Liza Hopkins, Prevention Centre
- Pippy Walker, Prevention Centre
- Dr Katie Conte, Prevention Centre
International Advisory Committee:
- Professor Lesley Barclay, The University of Sydney
- Professor Pennie Foster-Fishman, Michigan State University, US
- Professor Terry Huang, City University of New York, US
- Professor Barbara Riley, University of Waterloo, Canada
- Professor Andrew Wilson, Prevention Centre and The University of Sydney
We acknowledge the invaluable input into this project of our colleague, mentor, and above-all friend, Associate Professor Sonia Wutzke (1970–2017). The public health community is richer for having had you as one of its most passionate advocates.
This project was funded by the NHMRC, Australian Government Department of Health, NSW Ministry of Health, ACT Health and the HCF Research Foundation.
What is Prevention Tracker?
Prevention Tracker is working with local communities to better understand their prevention system; how the people, processes, activities, settings and structures in that community all connect to influence the health of local populations.
Prevention Tracker in Glenorchy is a partnership between the Prevention Centre, Glenorchy City Council and the Tasmanian Government Department of Health and Human Services.
The Prevention Tracker proof-of-concept pilot study based in Glenorchy, Tasmania’s fourth largest city on the northern edge of Hobart, ran across 2015. This pilot work was largely completed by mid-2016 and a final report on the pilot work was produced in July 2016.
In October 2016, a new MoU was signed between the Prevention Centre and the Prevention Tracker Glenorchy project partners to expand the work conducted in the pilot.
System Inventory, Organisational Network Survey and Social Network Analysis, Atlas of Liveability Indicators and Key Informant Interviews were completed in the pilot phase of the project.
Pilot data was used to inform a data synthesis workshop held in March 2017, which identified the following local problem:
The lack of skills, processes and commitment to collaborative practice undermines our ability to achieve a healthier community.
Three Group Model Building workshops involving local stakeholders in Glenorchy worked to unpack this local problem and identify potential points for action. A number of meetings with partner organisations were then held to facilitate the Action Learning agenda.
The Action Learning Team has been set up and the project team has been guiding its work.
Prevention Tracker in Albany is a partnership between the Prevention Centre and WA Country Health Service (WACHS) Great Southern Population Health.
Currently, 68% of Albany adults are not at a healthy weight, 49% need to do more physical activity and nearly 90% do not eat enough vegetables. These people are at increased risk of chronic diseases such as heart disease, cancer and type 2 diabetes.
Prevention Tracker is working with local stakeholders in prevention to help create a better understanding of the local prevention system, identify possible points for effective intervention and monitor the effects of changes on the way prevention is carried out locally.
The vision is that the findings of the Prevention Tracker project in Albany will help to guide the City of Albany, WA Country Health Service and other organisations as they work together to improve health and prevent chronic diseases, with a particular focus on overweight and obesity.
The Local Advisory Group had its first meeting in August 2016. A System Inventory of the key organisations, programs, policies and evaluations relevant to the local prevention system was developed. Six Liveability Indicators and a useful comparator community were established. A Community Snapshot of existing health and demographic data was produced.
The online Organisational Network Survey went live in Albany in September. This was followed by two weeks of face to face interviews with key local informants. Work then began to synthesise this large, disparate dataset. This work included the production of a large scale visual representation of the synthesised by a professional graphic recorder.
A Data Synthesis Workshop was conducted with key local stakeholders in Albany in early December. As a result of the Data Synthesis Workshop, a local problem was identified, namely:
How might we broaden the range of people and organisations engaged in improving the health of our community?
Three Group Model Building workshops involving local stakeholders in Albany worked to unpack this local problem and identify potential points for action. The workshops developed a causal loop diagram of factors relating to lack of engagement in preventative health activities and to identify a set of possible future actions.
Action Learning Teams have been set up and the project team has been facilitating the process and gathering data.
Prevention Tracker in Broken Hill is a partnership between the Prevention Centre and the Broken Hill University Department of Rural Health (Sydney University).
Prevention Tracker is working with the Healthy Broken Hill initiative. Healthy Broken Hill embodies a whole-of-community approach to addressing obesity, diabetes and cardiovascular disease.
A Local Advisory Group has been formed in Broken Hill to provide local knowledge and insights to help the design, implementation and interpretation of Prevention Tracker.
The first meeting of the Local Advisory Group was held in November 2016. The System Inventory was developed and completed by February 2017. A draft Community Snapshot has been prepared.
A data synthesis workshop was held in September 2017, involving engagement of the Local Advisory Group and other local stakeholders in further synthesis and interpretation of the data collected in the first part of the project. This led to the identification of a local key problem:
Existing community infrastructure does not maximise opportunities for collaboration both between diverse organisations working in prevention and between organisations and individuals or groups within the community.
A number of meetings with our partner organisation have been held to facilitate the action learning agenda.
Prevention Tracker in the Gold Coast is a collaboration between the Prevention Centre and Gold Coast Health.
The Gold Coast region stretches from Beenleigh in the north to Coolangatta in the south, and Springbrook and Ormeau in the western part of southeast Queensland. The estimated resident population is more than 560,000.
Due to the large size of the Gold Coast compared to the other Prevention Tracker communities, as well as the shorter timeframe available, Prevention Tracker in the Gold Coast is slightly different. In the Gold Coast, Prevention Tracker will focus on themes of interest to the recently established Preventative Health Working Group partnership. The System Inventory, Organisational Network Survey and Key Informant Interviews will involve members and activities of the Working Group as well as their intra-group and inter-group partnerships.
A data synthesis workshop was held in December 2017, which involved the engagement of local stakeholders in further synthesis and interpretation of the data collected in the first part of the project. This led to the identification of a local key problem to feed into the group model building workshops:
A lack of shared leadership for local collaborative program delivery and funding models has lead to inefficient use of resources and reduced consumer engagement, thereby thwarting our ability to co-create sustainable and equitable prevention solutions that meet community needs.
A team from Deakin University was engaged to facilitate two Group Model Building Workshops to unpack this local problem and identify potential points for action/intervention. These workshops developed a causal loop diagram of factors relating to the problem.
Roberts, N. Prevention Tracker: putting systems science to the test with local communities, World Congress on Public Health, Melbourne. April 2017.
Riley, T. World Leaders Dialogue: Exploring Systems approaches to chronic disease prevention, World Congress on Public Health, Melbourne. April 2017.
Riley, T. Living with uncertainty: behind the scenes of Prevention Tracker, World Congress on Public Health, Melbourne. April 2017.
- Prevention Centre news, April 2017: Prevention Tracker highlights key systems changes for communities
- Prevention Centre news, June 2016: Small wins in local communities make national change possible
- Prevention Centre news, October 2015: Prevention Tracker project learns from local wisdom