Support, feedback and monitoring
Guidance and support for PRISM Community Development Officers
Initial training and support
Prior to commencing work in the intervention municipalities, the community development officers participated in a five day residential training program [PDF 86KB] (9-13 November 1998) organised by the PRISM research team in conjunction with the two collaborating research teams, GAPP and EcoPRISM. This was followed by a further two-day training program [PDF 92KB] (9-10 December 1998) conducted shortly after commencement in the communities.
The objective of these initial training sessions was to prepare the eight PRISM community development officers (CDOs) for undertaking the local co-ordination of the PRISM intervention strategies in each municipality by providing:
- an outline of the background and rationale for the project;
- a detailed description of the key minimum elements of the intervention and the role to be played by the CDOs both in its implementation and its evaluation;
- an opportunity to get to know each other - CDOs and the research team - to foster a team approach to the project and to enable appropriate ongoing support to be provided when difficulties were encountered;
- for active participation by the CDOs in the training process to enable a fruitful exchange of ideas and the development of a collective understanding of ways of operating in the local context to maximise success, based on past experience of community development activities;
- an opportunity to explore areas of likely difficulty in project implementation and to pool our joint experiences in developing strategies to deal with these.
These initial training sessions, and the joint discussions about strategies and approaches to implementing PRISM that occurred during them, culminated in the PRISM research team compiling a Community Development Manual [PDF 82KB], designed to support the CDOs in their role as key facilitators of PRISM locally.
Day-to-day support during program implementation
Day-to-day support for the community development officers was provided by two members of the PRISM research team: Stephanie Brown and Rhonda Small, in their role as project co-ordinators. This support occurred via telephone, email and in person and involved providing guidance, being a sounding board for ideas, discussing any problems experienced, and providing an overview of PRISM as it unfolded across the eight intervention areas, with the aim of facilitating the work of the CDOs in each of their communities. Support was provided on a rotating basis every three to four months,with each co-ordinator supporting four CDOs at any one time.
All discussions were documented in a community file for each intervention municipality, so that both project co-ordinators were able to keep up to date with issues and developments in all eight areas and to provide advice and support based on this, and with knowledge about how issues were being tackled in other areas.
Joint whole-day meetings between the CDOs and the PRISM research team - and the collaborating research teams when appropriate - were held quarterly throughout the two-year appointments of the CDOs. These meetings enabled the sharing of ideas and strategies, discussion of common difficulties and challenges in implementing PRISM and the maintenance of a shared vision about the project. Meetings often resulted in the preparation of shared documents or resources for use across the intervention communities, such as a generic written agreement prepared for use with voucher contributors concerning the nature and extent of their voucher offers, or an overview of the various forms of evaluation being used in PRISM, in response to a community request.
Midway during project implementation, another such document was prepared by the PRISM co-ordinators to capture an overview of the 'intervention' as PRISM approached the end of the first year of implementation.
PRISM Overview - Halfway
'PRISM Overview - Halfway' [PDF 143KB] was an in-house account of the first year establishing PRISM, documenting what had been happening and also gathering together the range of ideas (generated at team meetings and in the field), to assist the CDOs in working with communities to integrate and sustain PRISM strategies beyond the two year implementation phase.
During the initial training program for the community development officers, a number of professional development ideas were raised that CDOs were keen to work on during their time with the project. CDOs had access to staff development funds available to all staff at the Centre for the Study of Mothers' and Children's Health for attendance at conferences or training courses and some of the issues were addressed for individual CDOs in this way.
In June 2000, the PRISM research team also organised a two-day professional development workshop [PDF 89KB] to provide the CDOs with an opportunity for input and discussion about future community development roles, with a particular focus on the local government context and marketing community development skills.
Keeping in touch in a 16-community project: Sharing information about PRISM
A range of strategies was devised in PRISM to keep in touch and share information about the project. Some of these were specific to our work with intervention communities and others involved both intervention and comparison areas.
PRISM Points: the project newsletter
PRISM Points was produced throughout the implementation and data collection phases of PRISM, in two formats: one for comparison communities, designed to keep everyone in touch with overall project progress and another for intervention communities designed also to enable sharing between communities of ideas and strategies for implementing the PRISM intervention program.
Examples of 'intervention' PRISM Points:
Examples of 'comparison' PRISM Points:
Local update briefings and meetings during PRISM: all communities
Update briefings were held annually with all sixteen participating communities, involving members of the PRISM research team visiting each area to meet with local participants in the project, in particular the nominated local government PRISM Contact Person, but also Maternal and Child Health Team Leaders, Community Service Managers, and Steering Committee Chairpersons (in intervention areas)
Community Forums 1999, 2000, 2001: intervention communities
Although not planned in the initial design of PRISM, a suggestion from maternal and child health nurses during their PRISM education program that it would be valuable for nurse teams across the intervention areas to get together to share their experiences of implementing PRISM, led to the organisation of three community forums during the project.
The first held in November 1999 [PDF 148KB] brought together maternal and child health nurses, GPs and General Practice Division representatives. The second in August 2000 [PDF 160KB] and the third in November 2001 [PDF 252KB], involved a range of local participants from intervention communities: recent mothers, local government managers, local councillors, community organisation representatives, maternal and child health nurses and GPs.
Process evaluation: finding out about the implementation of the key elements of PRISM and local participants' views
Process evaluation examines the reach of an intervention, how well it is implemented, the quality of its components and the satisfaction of various groups associated with it.
In PRISM we sought information on:
- participation in, and participant views of, the education programs for maternal and child health nurses and general practitioners:
- views of mothers about the value of the information kits and the responsiveness of maternal and child health nurses and general practitioners (outcome questionnaires to mothers)
- uptake of vouchers offered to mothers in the information kits (outcome questionnaire to mothers)
- the range and nature of befriending opportunities initiated and/or promoted for mothers:
- Befriending in PRISM [PDF 241KB]
- Program of resources, information and support for mothers (1) [PDF 802KB]
- Program of resources, information and support for mothers (2) [PDF 747KB]
- Program of resources, information and support for mothers (3) [PDF 1MB]
- Program of resources, information and support for mothers (4) [PDF 599KB]
- views of maternal and child health nurses and general practitioners about participating in PRISM:
- initiation/development of collaborative activities in primary care, particularly between GPs and maternal and child health nurses.
- how the Community Development Officers saw the intervention unfolding in each community (collected in records of emails and conversations with the PRISM co-ordinators and in notes of team meetings)
- the Steering Committee's views of the project (mid-project Communities' Feedback postal survey)
- the views of other key informants and parties (mid-project Communities' Feedback postal surveym [PDF 175KB])
- how the local media portrayed issues for mothers during the project - local newspapers' audit [PDF 125KB]
The policy and service context for PRISM 1999-2001
It is important in a project like PRISM, occurring over a number of years, that we are able to describe the context in which the project happened and any important changes which may have occurred in service delivery both in participating communities (both intervention and comparison) and more generally, over the study period.
We need to be able to answer two important questions satisfactorily:
Can we be sure that PRISM strategies were not implemented in comparison communities?
Was there a secular shift across the whole service system for recent mothers towards the types of strategies implemented in PRISM, that might have diluted any effect of the project?
A number of monitoring activities were therefore undertaken in order to be able to demonstrate whether or not PRISM was a package of strategies that we could be confident only occurred in PRISM intervention municipalities, and was quite different to what was happening for recent mothers in comparison communities and in the service system more generally.
These activities included:
- MCH team leader survey 2002: the MCH service 1999-2001
- Audit of local government activity
- Audit of General Practice Division activity
This monitoring enabled comparisons with data collected in intervention communities during PRISM.
- Mapping of State and Commonwealth government policies and programs [PDF 184KB] relevant to maternal health during the PRISM implementation period 1999-2001.