Ritchie Deborah, Gnich Wendy, Parry Odette, Platt Steve
Nursing Studies, School of Health in Social Science, University of Edinburgh, UK.
BMC Public Health. 2008 May 22;8:173. doi: 10.1186/1471-2458-8-173.
A community public health programme, 'Breathing Space', aimed to tackle smoking in a low income area in Scotland. This paper draws on the qualitative process evaluation of a community-based initiative 'Breathing Space', which set out to tackle smoking in a low income area of Scotland, in order to explore user perceptions of key factors affecting implementation, and in particular to explore the implications of participant knowledge and expertise for programme stability and continuity.
The overall evaluation of Breathing Space used a quasi-experimental design and incorporated a detailed process evaluation. The process evaluation aimed to document development and implementation of the programme using a range of qualitative methods, including observation, in-depth interviews, focus groups and documentary analysis. The paper draws upon 59 semi-structured in-depth interviews which were carried out as part of the process evaluation.
Staff numbers from the multi-agency partnership dwindled across the lifecouof the programme and respondents identified lack of continuity as a key issue. While staff changes are an anticipated problem in programme implementation, here we draw on concepts of technicality and indeterminacy to explore the different aspects of public health programmes which are forfeited when individuals leave. The paper argues that, while technical components of public health programmes (such as the importance of staff complement and continuity) are widely recognised, it is the more indeterminate aspects, including the loss of key theoretical understanding underpinning the programme, which most affect programme delivery. Indeed, the paper suggests that, where inadequate planning and resources threaten the continuity of indeterminate knowledge, the success of public health programmes may be especially jeopardised.
Community-based programmes which rely strongly on partnership processes would benefit from early consideration of the potential risks associated with both expected and unexpected stakeholder change. Building in appropriate contingency plans is necessary for sustaining the theory and culture of the programme. Evaluations of innovative community development initiatives may benefit from a formative approach.
一项名为“喘息空间”的社区公共卫生项目旨在解决苏格兰一个低收入地区的吸烟问题。本文借鉴了对一项以社区为基础的倡议“喘息空间”的定性过程评估，该倡议旨在解决苏格兰一个低收入地区的吸烟问题，以探讨用户对影响实施的关键因素的看法，特别是探讨参与者的知识和专业技能对项目稳定性和连续性的影响。
“喘息空间”的总体评估采用了准实验设计，并纳入了详细的过程评估。过程评估旨在通过一系列定性方法记录该项目的发展和实施情况，包括观察、深入访谈、焦点小组和文献分析。本文借鉴了作为过程评估一部分进行的59次半结构化深入访谈。
在项目实施过程中，多机构合作伙伴关系中的工作人员数量逐渐减少，受访者认为缺乏连续性是一个关键问题。虽然工作人员变动是项目实施中一个预期的问题，但在此我们运用专业性和不确定性的概念来探讨公共卫生项目在人员离开时丧失的不同方面。本文认为，虽然公共卫生项目的技术组成部分（如工作人员配备和连续性的重要性）已得到广泛认可，但更具不确定性的方面，包括支撑项目的关键理论理解的丧失，对项目实施影响最大。事实上，本文表明，在规划和资源不足威胁到不确定知识的连续性时，公共卫生项目的成功可能会尤其受到损害。
严重依赖伙伴关系流程的社区项目将受益于尽早考虑与预期和意外的利益相关者变化相关的潜在风险。制定适当的应急计划对于维持项目的理论和文化是必要的。对创新性社区发展倡议的评估可能受益于一种形成性方法。
