Gwyn Jolley

This paper examines recent Australian health reform policies and considers how the primary health care (PHC) workforce experiences subsequent change and perceives its impact on health promotion practice. Health policy documents were analysed to determine their intended impact on health promotion. Interviews were conducted with 39 respondents from four State-funded PHC services to gain their perceptions of the impact of policy change on health promotion. There have been a plethora of policy and strategy documents over the last decade relevant to PHC, and these suggest an intention to strengthen health promotion. However, respondents report that changes to the role and focus of PHC services have led to fewer opportunities for health promotion. Services are struggling to engage in health promotion activity, while funding and policy directions are prioritised to targeted, individual behaviour change. The experience of PHC workforce respondents in South Australia suggests that, despite policy intentions, health promotion practice is much reduced. Our research suggests that rigorous evaluation of health sector reforms should be undertaken to assess both intended and unintended outcomes in terms of service quality and delivery. Health promoters are experiencing a contradictory policy and practice environment, and this research should assist health promoters in advocating for more government accountability in the implementation of policies in order to advance comprehensive PHC.?

This paper describes the development of a model of Comprehensive Primary Health Care (CPHC) applicable to the Australian context. CPHC holds promise as an effective model of health system organization able to improve population health and increase health equity. However, there is little literature that describes and evaluates CPHC as a whole, with most evaluation focusing on specific programs. The lack of a consensus on what constitutes CPHC, and the complex and context-sensitive nature of CPHC are all barriers to evaluation.

The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia.

Job loss is a discrete life event, with multiple adverse consequences for physical and mental health and implications for agency. Our research explores the consequences of job loss for retrenched workers’ mental health by examining the interplay between their agency and the structures shaping their job loss experiences.

Issue addressed This paper reports on the development of a planning and evaluation framework and tools to assess key principles of primary health care/health promotion: community participation, collaborative partnerships and a focus on equity. The focus of the tools is on planning and process evaluation with some outcome questions included. Methods Following a scan of literature, the framework and tools for each component were developed. The tools were road‐tested with colleagues and trialled by workshop participants. Results A framework and tools for each of the components and ways to assess how effectively they are applied at the program and practice level was developed. The tools attempt to deal with evaluation challenges by providing primary health care/health promotion practitioners and evaluators with a framework to examine these components of their work. Conclusions Planning and evaluation are regarded as routine in good practice. As health promotion practice and programs are shaped by principles such as partnerships, participation and equity, it is important that we also apply an evaluation lens to these components. Sound planning and evaluation allows practitioners to explain how and why these principles are integrated into their work and what is achieved. So what? The development of a pragmatic evaluation framework for each of the key principles will assist practitioners to build a sound evidence base, not only about their individual practice or program, but also about an approach to health care which holds considerable promise to meet the health challenges of this century.

This article reports on the evaluation of an action research project designed to support workforce development in the promotion of healthy nutrition for older people. The evaluation methodology was grounded by the action research approach of the project and focused on case studies of the 10 partner organisations. Findings indicate that the Healthy Ageing—Nutrition Project has resulted in a large increase in awareness and knowledge about healthy ageing and nutrition in the case study organisations, and to a lesser extent, in the broader health and aged care sectors. For the case study organisations it seems likely that transformational change has been made through the project's work of building capacity, mediating and facilitating change and providing resources. Support at board and management level, as well as thoughtful development of the workforce, were critical success factors in bringing about organisational change. The main challenge was identified as time and resources needed. Follow-up evaluation of the health outcomes from nutritional assessment, screening and intervention should also be implemented in order to provide further evidence of the value of this effort.

An assessment of the quality of program evaluations conducted in South Australian community health services investigated how effective evaluation reporting is in producing an evidence base for community health. Evaluation reports were assessed by a team of reviewers. Practitioner workshops allowed an understanding of the uses of evaluation and what promotes or acts as a barrier to undertaking evaluations. Community health services do undertake a good deal of evaluation. However, reports were not generally explicit in dealing with the principles that underpin community health. Few engaged with program theory or rationale. Typically, reports were of short-term projects with uncertain futures so there may seem little point in considering issues of longterm health outcomes and transferability to other settings. The most important issue from our study is the lack of investment in applied health services research of the sort that will be required to produce the evidence for practice that policy makers desire. The current lack of evidence for community health reflects failure of the system to invest in research and evaluation that is adequately resourced and designed for complex community settings.