Evaluation matrix for health promotion programs in socially vulnerable territories

Oliveira, Rosana Therezinha Queiroz de; Ignacio, Caroline Ferraz; Moraes, Antonio Henrique Almeida de; Barata, Martha Macedo de Lima

doi:10.1590/1413-812320172212.24912017

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Article • Ciênc. saúde colet. 22 (12) • Dec 2017 • https://doi.org/10.1590/1413-812320172212.24912017 copy

Evaluation matrix for health promotion programs in socially vulnerable territories

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Health promotion has a set of strategies for advancing health and reducing inequalities. However, evaluating the effectiveness of health promotion programs has been a challenge. This paper shows the development and application of the Evaluation Matrix, constructed with qualitative-quantitative and multidimensional indicators supported by public policies targeting socially vulnerable territories. This is a cross-sectional study with the implementation of a health promotion program in order to develop an Evaluation Matrix to be applied in two distinct socio-environmentally vulnerable areas. The Evaluation Matrix proved to be easily applicable and enabled the detection of strengths and weaknesses of health promotion programs applied in different territories. The participation of managers, teams, population and multiple sectors of society was decisive for the success of the program. Furthermore, community health workers stood out as essential stakeholders due to their linkages with the population. Contributions include a tool and methodology for evaluating health promotion programs to be applied in different territories and modified according to the territory.

Key words
Primary Health Care; Inequities; Territory

PNPS principles	Descriptors
Sustainability	D.1. Requires permanent and continuous actions and interventions, taking into account the political, economic, social, cultural and environmental realms.
Intrasectoriality	D.2. Adherence of local health managers in the planning, development, control and evaluation process.
Intrasectoriality	D.3. Participation of other sectors linked to health promotion, aiming at the construction of cooperative and resolutive networks.
Intersectoriality and social participation	D.4. Participation of different stakeholders in the planning, development, control and evaluation process.
Intersectoriality	D.5. Partnerships with other municipal, state and federal institutions.
Sustainability	D.6. Adequate space to carry out the different actions of the Health Promotion Program.
	D.7. Allocation of specific financial resources to carry out the PPS.
	D.8. Training and adherence of the team to carry out the Health Promotion Program.
Territoriality	D.9. Recognizing the knowledge, attitudes and practices of the population.
Territoriality	D.10. Recognizing socio-environmental determinants.
Territoriality	D.11. Recognizing the epidemiological profile of the population.
Equity	D.12. Recognition of vulnerable situations (complexity and uniqueness) of individuals and groups.
Empowerment	D.13. Intervention encourages subjects to seize control of decision-making and lifestyle choices (self-care).
Territoriality	D.14. Valuing popular and traditional knowledge and integrative and complementary practices.
Integrality	D.15. Considering the complexities, singularities and specificities of individuals and groups in the territory.
Social participation	D.16. Equitable participation of the population.
Intersectoriality	D.17. Participation of different professionals.
Territoriality	D.18. Monitoring and comparison of socio-environmental determinants of health.
Territoriality	D.19. Monitoring and comparison of knowledge, attitudes and practices of the population.
Territoriality	D.20. Monitoring and comparison of the epidemiological profile of the population.
Autonomy	D.21. Individuals may choose priorities consciously, considering the group.
Sustainability	D.22. Recognition of results by local team, managers and population.
Sustainability	D.23. Requires permanent and continuous actions and interventions, taking into account the political, economic, social, cultural and environmental realms.

Score	Time
1 point	Less than 6 months
2 points	6 months
3 points	6 months to 1 year
4 points	1 to 2 years
5 points	Over 2 years¹⁶16. Prata PR. The Epidemiologic Transition in Brazil. Cad Saude Publica 1992; 8(2):168-175.

HEALTH PROMOTION PROGRAM EVALUATION MATRIX
Realms	Questions	Qualitative Indicator	Quantitative Indicator	Pontos
Context	1. Is the Health Promotion Program included in the report of the Municipal Health Conference and the Municipal Health Plan?	( ) Yes ( ) No ( ) Don't know	-
	2. Did local managers participate in the Health Promotion Program?	( ) Yes ( ) No ( ) Don't know	-
	2.1. When did this participation occur?	-	Select all that apply.
			( ) Planning
			( ) Execution
			( ) Monitoring
			( ) Assessment
	3. Has the Health Promotion Program counted on the participation of other sectors linked to health promotion (education, social welfare, environment, others)?	( ) Yes ( ) No ( ) Don't know	-
	3.1. Which were these sectors?	-	Select all that apply.
			( ) Education
			( ) Social welfare
			( ) Environment
			( ) Other:
	3.2. When did these sectors participate?		Select all that apply.
			( ) Planning
			( ) Execution
			( ) Monitoring
			( ) Assessment
	4. Has the Health Promotion Program counted on the participation of different stakeholders?	( ) Yes ( ) No ( ) Don't know	-
	4.1. Which were these stakeholders?	-	Select all that apply.
			( ) Individuals
			( ) Press
			( ) Institutions
			( ) Organized groups
			( ) Councils
			( ) Entities
			( ) Trade Unions
			( ) Churches
			( ) Political parties
			( ) Other:
	4.2. When did they participate?	-	Select all that apply.
			( ) Planning
			( ) Execution
			( ) Monitoring
			( ) Assessment
	5. Has the Health Promotion Program counted on the partnerships of municipal, state and federal institutions?	( ) Yes ( ) No ( ) Don't know	-
	5.1. Which were these partnerships?	-	Select all that apply.
	5.1. Which were these partnerships?	-	( ) Municipal ( ) Federal ( ) State ( ) Other:
	5.2. When did they participate?		Select all that apply.
			( ) Planning
			( ) Execution
			( ) Monitoring
			( ) Assessment
Structure	6. Was the space available to carry out the Health Promotion Program adequate?	( ) Yes ( ) No ( ) Don't know	-
	7. Has the Health Promotion Program obtained the necessary financial resources for its own implementation?	( ) Yes ( ) No ( ) Don't know	-
	8. Has the team adhered to perform the Health Promotion Program?	( ) Yes ( ) No ( ) Don't know	-
	8.1. Was the team trained to carry out the Health Promotion Program?	( ) Yes ( ) No ( ) Don't know	-
Process	9. Was a survey conducted on the knowledge, attitudes and practices of the population?	( ) Yes ( ) No ( ) Don't know	-
Result	9.1. Did the ESF team identify the knowledge, attitudes and practices of the population?	( ) Yes ( ) No ( ) Don't know	-
Process	10. Was a socio-environmental survey conducted on the population?	( ) Yes ( ) No ( ) Don't know	-
Result	10.1 Did the ESF team identify the socioenvironmental profile of the population?	( ) Yes ( ) No ( ) Don't know	-
Process	11. Was an epidemiological survey conducted on the population?	( ) Yes ( ) No ( ) Don't know	-
Result	11.1. Did the ESF team identify the epidemiological profile of the population?	( ) Yes ( ) No ( ) Don't know	-
Process	12. When identifying situations of vulnerability (complex and/or unique cases) of individuals or groups, was the team capable of producing responses?	( ) Yes ( ) No ( ) Don't know	-
	13. Was the “Educational Action” performed?	( ) Yes ( ) No ( ) Don't know	-
	13.1. Has the methodology used led to the questioning of the topics covered?	( ) Yes ( ) No ( ) Don't know	-
	13.2. Did it favor the collective construction of new strategies?	(( ) Yes ( ) No ( ) Don't know	-
	13.3. Did it change the lifestyles / habits (self-care)?	( ) Yes ( ) No ( ) Don't know	-
Process	14. What were the activities performed in the “Educational Action”?	-	Select all that apply.
			( ) Workshops
			( ) Creation of sentences (slogan)
			( ) Educational games
			( ) Conversation rounds
			( ) Guides or manuals
			( ) Role play
			( ) Posters
			( ) Lectures
			( ) Other:
	15. Was “Education Action” planned from the identified problem situation?	( ) Yes ( ) No ( ) Don't know	-
	15.1. Was educational material distributed?	( ) Yes ( ) No ( ) Don't know	-
	15.2. Was the language used in the educational material adequate to the socio-cultural reality and knowledge of the population?	(( ) Yes ( ) No ( ) Don't know	-
	16. Has the population adhered to the “Educational Action” performed?	( ) Yes ( ) No ( ) Don't know	-
	16.1. What means of dissemination were used to invite the population to the “Educational Action”?	-	Select all that apply.
			( ) Home visit
			( ) Car audio messaging
			( ) Flyers
			( ) Social networks
			( ) Electronic mail
			( ) Other:
	17. Have professionals from other areas participated in the initiative?	( ) Yes ( ) No ( ) Don't know	-
Process	18. Was a socio-environmental survey conducted after the “Educational Action”?	( ) Yes ( ) No ( ) Don't know	-
	18.1. How long after the “Educational Action”?	-	( ) Below 6 months
			( ) 6 months
			( ) Between 6 months and 1 year
			( ) Between 1 and 2 years
			( ) Over 2 years.
Result	18.2. Has the ESF team identified improvements in the socio-environmental conditions?	( ) Yes ( ) No ( ) Don't know	-
Process	19. Was a survey on the knowledge, attitudes and practices of the population conducted after the “Educational Action”?	( ) Yes ( ) No ( ) Don't know	-
	19.1. How long after the “Educational Action”?	-	( ) Below 6 months
			( ) 6 months
			( ) Between 6 months and 1 year
			( ) Between 1 and 2 years
			( ) Over 2 years.
Result	19.2. Has the ESF team identified the appropriation of knowledge, attitudes and practices by the population?	( ) Yes ( ) No ( ) Don't know	-
Process	20. Was a survey on the epidemiological profile of the population conducted after the “Educational Action”?	( ) Yes ( ) No ( ) Don't know	-
	20.1. How long after the “Educational Action”?	-	( ) Below 6 months
			( ) 6 months
			( ) Between 6 months and 1 year
			( ) Between 1 and 2 years
			( ) Over 2 years.
Result	20.2. Has the ESF team identified improvements in epidemiological profile?	( ) Yes ( ) No ( ) Don't know	-
Process	21. Did the population and the stakeholders participate in defining the priority themes of “Educational Action”?	( ) Yes ( ) No ( ) Don't know	-
	22. Were the results discussed by local staff and managers?	( ) Yes ( ) No ( ) Don't know	-
	22.1. Were the results disseminated to the population?	( ) Yes ( ) No ( ) Don't know	-
	22.2. What were the dissemination strategies?		Select all that apply.
			( ) Periodic meeting of the ESF team
			( ) Meeting of the Municipal Health Council
			( ) Web page
			( ) Social network
			( ) Form for suggestions, criticisms and comments
			( ) Other:
Continuity	23. Was there an indication of development and / or further analysis of the themes based on the evaluation of the results of the Health Promotion Program?	( ) Yes ( ) No ( ) Don't know	-
	23.1. Was there an indication of permanence, aiming at the institutionalization of the Health Promotion Program?	( ) Yes ( ) No ( ) Don't know	-
	23.2. Has the Health Promotion Program been maintained in the report of the Municipal Health Conference and the Municipal Health Plan?	( ) Yes ( ) No ( ) Don't know
TOTAL
Matrix Score
Intervals 104 to 130 77 to 103 50 to 76 23 to 49 0 to 22			Classification Excelent Very good Good Bad Very bad

Realm	Strengths
Context	Adherence of managers, staff, population, the various sectors involved in health promotion and stakeholders.
Context	Partnership with FIOCRUZ.
Structure	Physical space and adequate financial resources, training of health and endemic workers.
Processes	Performing pre-test, educational and post-test actions with participation of the population, stakeholders and other sectors linked to health promotion.
Processes	Dissemination of results.
Results	Treatment and follow-up of the parasitized individuals.
Realm	Weaknesses
Continuity	Lack of sustainability.

Realms	Strengths
Structure	Team adherence.
Continuity	Signs of in-depth analysis of themes development.
Continuity	Program remained in the report of the Municipal Health Conference and the Municipal Health Plan.
Realms	Weaknesses
Context	Lack of engagement of stakeholders and other sectors linked to health promotion.
Processes	“Not knowing” whether a survey on KAP; socio-environmental conditions and epidemiological profile after the educational actions was performed.
Processes	“Not knowing” whether results were disseminated to the population.

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[1] Collaborations

RTQ Oliveira, CF Ignacio, AHA Moraes Neto and MML Barata contributed equally to the paper.