Neighbourhood Health Watch evaluation
Realist evaluation – what are the different contexts? What are the different mechanisms or structures that have made something happen? What has happened?
Looking a lot at process – what happens in practice. Each Watch develops differently according to the community and the needs/wants of that community and so we have been collecting information about how they are developing and what the different outcomes are.
Neighbourhood Health Watch Interim Evaluation.
The proposal was that Neighbourhood Health Watch Groups would be established around an agreed common purpose, be co-ordinated by a volunteer, display signage that they belong and meet with each other regularly to share experience and ideas. There would then be the opportunity for health professionals to visit the meetings to act in the role of health coach, giving advice on prevention and management of conditions, answering questions and guiding people to useful resources accessible to them.
Defining the model was to be done through testing and retesting until key core components have been established. The early watches are monitored closely to identify the mechanisms of development and to see what the key characteristics are for success or otherwise.
The first step was therefore to test the theory in the real world, and in the early stages of the Neighbourhood Health Watch project, the team talked to stakeholders and interested parties to verify the relevance of the NHHW concept and obtain real-life information to be fed into creating a practical NHHW model.
These early discussions with stakeholders, coupled with analysis of the brand and concept provided the cornerstone for creating a model of Neighbourhood Health Watch. We had defined our customers, from community members to service providers, gained some insight into the needs and wants of communities and service providers, and identified the importance of key concepts such as trust. We had identified the issues around information provision and information use, access of communities to services, and access to communities of service providers. And importantly, we had started to understand the heterogeneity of communities and the ways in which they look after each other, and the implications of that for Neighbourhood Health Watch.
The emerging model was defined around the “sides of the streets”. On one side of the street are the members of the community. They interact in various ways, depending on levels of interaction within the community and between individuals. This is bonding social capital – the extent to which people create and maintain social relationships between each other. There are certain people on this side of the street who have particular knowledge or value in terms of health, care and support, for example a retired GP, a lead of a Neighbourhood Watch, or a volunteer for a local care charity. Discussions between neighbours will enable communities to help each other as they recognize these resources within their community. But they also need to make links beyond their community – otherwise known as “bridging” social capital.
On the other side of the street there is information and service provision from charities, statutory and non-statutory services and businesses. Those groups are trying to access the community, but may have difficulty in finding their way to those who are the least obvious, and who may be those who need help the most. In particular, preventative support and care is difficult to target.
Neighbourhood Health Watch will sit in the middle of the street, providing the setting for conversations that enable communities to help each other and a bridging role from one side to the other. For the communities, this will mean moving beyond bonding social capital which links them to each other, to bridging social capital which gives them the power to link to those outside of their group. For the service providers, they can use NHW to link into communities.
The model of practice, taken from the original proposal, was to have groups formed with one co-ordinator, through which information to the group could be shared and the wider community. The groups would then link to the wider community, providing support when needed and would also be a point of contact for outside agencies.
Putting it into practice.
Following discussion about how best to start the pilots, the decision was made to start by piloting the project in our own backyards, seeing if we can make it work in a context that matters to us and that we think we know. We felt that piloting in our communities gave us some advantages, in that we should have quite a good understanding of where we live, but also some challenges, in particular that we would need to make it work and be a positive influence in our own community. We would be taking full responsibility for a project which would impact on ourselves and our neighbours. We started with four pilots: Heavitree – a district of Exeter, East Budleigh – a village East of Exeter, Longdown, a village 3 miles North of Exeter and Harbertonford, a village 5 miles south of Totnes in the South Hams.
Each pilot area differs from the next, and we started with an understanding of the basic workings of the project (a group with a coordinator, a contact system from community and provider to the group, and maybe a directory), but no practical model as to how to put it into practice. This was to be worked out from the start, with each pilot doing it in the way that best fitting the community in question in terms of how it worked socially, how providers linked the community and what needs there were in the community.
The seven steps
From these experiences of setting up the groups, a model started to emerge of the “seven steps” to creating a Neighbourhood Health Watch. These seven steps were defined as follows:
Step 1 – understand the idea.
Step 2 – find your activist
Step 3 – agree a base
Step 4 – engage your GP and local PCSO
Step 5 – find your helpers
Step 6 – engage the charities
Step 7 – can local businesses help