Practical Public Health Nutrition

Professor Roger Hughes is based at Griffith University, Gold Coast Campus, Australia. Professor Barrie Margetts is based at the University of Southampton, UK.

Preface ix

Acknowledgements x

Glossary xi

Part 1 Introduction and context 1

1 The big picture: The context for a textbook on public health nutrition practice 3

Why develop a public health nutrition textbook? 3

Malnutrition is still the main game 3

Innovative solutions are needed 4

Surely you don’t mean these challenges can be found in rich countries like mine? 4

Level of influence 5

Practice informed by a public health approach 5

First, work to understand the causes, by looking upstream 5

Practitioners and politics 6

The philosophy underpinning this book 6

Building capacity for effective public health nutrition action 7

2 Defining public health nutrition as a field of practice 9

Introduction 9

Modes of nutrition practice 10

Definitions of public health nutrition 12

An emphasis on the prevention of food and nutrition problems 12

The core functions of the PHN workforce 15

Competencies for PHN practice 17

Professionalism and PHN practice 18

3 A framework for public health nutrition practice 21

Introduction 21

A socio-ecological approach to practice 21

The PHN practice cycle 22

Recognising the importance of capacity building as a discrete strategy and as an approach to practice 23

Why make things more complicated and introduce a new framework? 25

A bi-cyclic framework for public health nutrition practice 28

Part 2 Intelligence 29

4 Step 1: Community engagement and analysis 31

Introduction 33

What is a community? 33

Why Community engagement? 33

Community development constructs 34

Community development – a process or an outcome? 36

Building community capital (and capacity) 37

Building capacity via ‘bottom-up’ practice 38

Community analysis 40

5 Step 2: Problem analysis 43

Introduction 45

Public health intelligence 45

What is Problem analysis? 46

Types of need 47

Conducting a Problem analysis 47

Different methodological approaches to gather intelligence for problem assessment 51

Applying the intelligence and analysis results 53

6 Step 3: Stakeholder analysis and engagement 57

Introduction 59

Why stakeholder engagement? 59

Stakeholder analysis 60

Considerations for Stakeholder analysis 60

Conducting the Stakeholder analysis 61

Organising and presenting Stakeholder analysis data 63

Stakeholder engagement 67

Engaging stakeholders in decision-making 67

7 Step 4: Determinant analysis 71

Introduction 73

Analysing determinants 73

Characterising determinants by their effect 74

Characterising determinants by the type of causal link 75

Characterising determinants by level 76

Determinant interaction and causal pathways 77

Diagrammatic illustration of determinant analysis 79

8 Step 5: Capacity analysis 81

Introduction 83

What is capacity? 83

A framework for capacity building practice 84

Capacity assessment for capacity building 84

Challenges in measuring capacity 86

Selecting tools for Capacity analysis 86

Tools and strategies for analysing capacity 89

Presenting Capacity analysis data 96

9 Step 6: Mandates for public health nutrition action 99

Introduction 101

Mandates for action – the policy context 101

Policy development – an overview 102

The challenge of competing policy agendas 103

National food and nutrition policies 104

Mandates for action – direct relevance to PHN practice 104

10 Step 7: Intervention research and strategy options 107

Introduction 109

Strategic frameworks for health promotion 109

Determinants as leverage points for intervention 113

Levels of intervention 113

Settings as a focus for intervention 113

Target groups as a focus for intervention 115

Intervention research: learning from earlier work 116

Abstracting intelligence from intervention research 117

11 Step 8: Risk assessment and strategy prioritisation 121

Introduction 123

Assessing risks and benefits 123

Types of risks and benefits 125

Strategy prioritisation 125

Challenges and dilemmas in strategy prioritisation 126

Methods for strategy prioritisation 127

Part 3 Action 137

12 Step 9: Writing Action statements 139

Introduction 141

Intervention planning 141

Action statements 142

Linking problem and determinant analysis to Action statements 142

Writing intervention goals 144

Writing intervention objectives 145

13 Step 10: Logic modelling 151

Introduction 153

What is a logic model? 153

Types of logic model 154

Logic model elements 155

Logic modelling in PHN practice 156

Developing a logic model 157

Key questions for reviewing logic models 157

14 Step 11: Implementation and evaluation planning 161

Introduction 163

Engaging stakeholders in intervention and evaluation planning 163

Planning for intervention implementation 164

Developing work package plans 166

Work scheduling – developing a Gantt chart 168

Developing intervention budgets 169

Evaluation planning 172

Levels of evaluation 173

Developing evaluation indicators and plans 175

15 Step 12: Managing implementation 179

Introduction 181

Types of PHN intervention implementation 181

Governance 182

Managing risk 185

Partnership satisfaction 186

Evaluability assessment 188

Part 4 Evaluation 191

16 Step 13: Process evaluation 193

Introduction 195

Evaluation – a brief overview 195

Linking evaluation to planning 196

Qualitative and quantitative approaches to evaluation 196

Levels of evaluation 197

Process evaluation 197

Elements of process evaluation 198

Methods for conducting process evaluation 202

Process evaluation indicators 202

Process evaluation in practice – some published examples 206

17 Step 14: Impact and outcome evaluation 207

Introduction 209

Impact and outcome evaluation – what is the difference? 209

When to evaluate? 210

Key measures of Impact and outcome evaluation 211

Reliability and validity in evaluation 214

Sampling and data analysis 215

Evaluation design 218

18 Step 15: Evaluating capacity gains 221

Introduction 223

Challenges in measuring capacity 223

Pre- and post-intervention comparisons 226

Strategies to enhance the trustworthiness of capacity evaluation 227

Visual presentations of capacity evaluations 228

19 Step 16: Economic evaluation 231

Introduction 233

Costs and consequences in health care 233

Characteristics of Economic evaluation 233

Types of Economic evaluation 234

Conducting an Economic evaluation 237

Efficiency vs. equity 237

20 Step 17: Reflective practice and valorisation 243

Introduction 245

What is Reflective practice? 245

Transformatory learning and Reflective practice 245

Improving practice through reflection 245

Stages of Reflective practice 246

Methods of Reflective practice 246

Tools for Reflective practice 248

What is valorisation? 249

Targets of valorisation 250

Methods of valorisation 250

Presenting intervention results 253

Appendices 257

1 Intervention plan template 259

2 Capacity building analysis tool 267

References 277

Index 284