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Shifting gears

A “learn as we go” approach yields surprising insights for innovative program development

When it comes to community health promotion, planning on paper can only take you so far. The real test is when you start implementing. Will your interventions gain traction, or will they fall flat? And how can you effectively learn and adapt your program as you go so you don’t waste precious time and resources on activities that don’t prove effective?

This was the challenge for Fraser Health’s South Asian Health Institute as it planned a community-based initiative for health promotion and disease prevention within the region’s South Asian community.

Research has shown that people of South Asian descent are two-to-three times more likely to experience heart disease, kidney disease, stroke and diabetes – and ten years earlier – compared to other ethnic groups.

Deljit Bains

Deljit Bains

Program planners determined that reaching out to this community would require an innovative approach that left the usual clinical setting behind. “We knew that getting out into the community and building partnerships were key,” says Deljit Bains, leader of the South Asian Health Institute. What emerged was the Sehat Wellness Ambassadors initiative, a concept where trained community volunteers would visit local religious temples to provide a wide variety of health information and resources.

Recognizing the need to evaluate their work, Fraser Health asked IHSTS to help. IHSTS CEO Linda Peritz suggested that Developmental Evaluation (DE) would be a useful approach and asked consultant Denise Withers to meet with the team.  DE is an evaluation approach that provides a structured “learn as we go” process to help team members rapidly develop, test, evaluate and refine their initial program activities and model. Denise was then contracted to work with the team and develop a DE framework to use as they launched a variety of activities.

A number of important discoveries emerged right from the start. “Engaging people at the temple seems like the obvious, easiest solution,” says Deljit, but there were still multiple barriers: health authority policies that didn’t account for using volunteers off-site; challenges in conducting effective health education and program evaluation in a bustling temple environment; issues of literacy and health knowledge among new community members; and cultural shifts that see fewer people regularly visiting temple.

“The program’s theory design was solid, but we saw quite clearly that the implementation needed to be refocused,” says Denise. Still, she encouraged the team to view their experiences as essential and valuable. “It’s okay to have some interventions fail,” she stresses. “It’s about creating real impact, not just ticking off boxes to show you’ve been busy.”

The Developmental Evaluation process also revealed important opportunities. The team noted that the South Asian community in the region is keen to support the Sehat initiative – politically, logistically and financially. Community leaders, organizations and businesses are interested in working together to help this initiative.

Innovative approaches like this are exactly what’s required to take on emergent, complex initiatives where the process and outcomes are not clear.

– Denise Withers

Based on their insights, the Sehat team has switched gears for Phase 2 of the project, with Denise’s continued support and coaching. Fraser Health leadership has endorsed a shift to a Patient-Centred Design Lab approach, which emphasizes a more collaborative approach to program development with community members.

In the kitchenThe team is also moving forward with a newly-focused project scope. For now, the project will target new Canadians aged 30-50 and focus on nutritional wellness. Work has begun with just a few temples to improve the nutrition of the food offered in their kitchens and to share nutritional information with their members. Once these interventions have been tested, evaluated and refined, they can be scaled up across the community. The Sehat team is also developing an interactive social network map and asset map to help them identify, connect and enable a network of existing community resources.

Deljit feels very positive about IHSTS’ supporting role in the Sehat initiative. “It’s been huge,” she says. “We’ve been able to observe, evaluate and make changes as we go along. The project would never be this far along without this type of support.”

Deljit recently presented the initiative to very positive response at a social innovation conference in Toronto that focused on South Asian health. “It was good to show that we are actually ‘doing’ innovation while others are still talking about how to do it,” she says.