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Minutes Strand meetings 1 Getting Evidence into Practice

ANNEXE September 2005 Project Getting Evidence into Practice Project (Evidence Consortium, GEP, European Commission Grant agreement no 2003123 (790841). Minutes three Strand meetings Getting Evidence into Practice, Project no. 2003123 (790841) Dates 30th September – 1st October 2004 Woerden, the Netherlands 3-4 February 2005-10-10 Woerden, the Netherlands

31th May - June 1, 2005 pre-conference Strand meeting Stockholm, Sweden


Minutes Strands meeting the strands project Getting Evidence into practice (GEP) EC project no.20031123 (Evidence Consortium 790841) Two-days-meeting: Thursday 30th September and Friday 1st October, 2004 Location: NIGZ, Woerden, the Netherlands DAY I (10.00 am-17.45 pm) Opening and welcome Chairperson Gerard Molleman (project manager NIGZ) opens the meeting at 10.00 am welcoming 35 participants. Short introduction of names and positions (see appendix list of participants). Jan Bouwens, project co-ordinator, summarizes the state of the art within the three strands, describing the aims and objectives of the original proposal and the changes that had to be made after just one third of the estimated financial support by the European Commission was granted. The main aim of the project is to strengthen the evidence base of health promotion and public health in Europe by developing an interrelated set of consensus-based instruments and increasing the capacity to use these instruments. The acronym for the project is European Consortium with the following project organisation: NIGZ is responsible for overall co-ordination and management, the EU contacts, the evaluation and in collaboration with EHN and partners the involvement of potential and partners/members and the expansion of the partnership. Strand holders are responsible for the work process in order to guarantee the necessary output and products. Project members participate in meetings, prepare and contribute to the strand work for instance, what has been done in their own context about quality assessment instruments and deliver valuable input. Partners are committed to follow the progress and can take part in meetings and seminars. Just like members they are willing to take the responsibility for the spreading and dissemination of the results in their own context. Affiliated partners are new and promising contacts during the project progress and interested followers/relevant parties in a (possible) new phase. Strands Strand one: the review protocol focuses on questions on how to search, select, judge and summarise evidence and what quality criteria are important for the review process. Strand two: guidelines, aims to come to an quality assessment protocol and a set of guidelines to increase the quality of health promotion projects. Strand three is engaged in the production of up-to-date reviews in selected topics and the update of the current state of the art evidence regarding HP as given in the IUHPE European publication. The results from the work during the past months are presented during this strand meeting. Jan Bouwens praises the efforts and results established by the three strands so far. Strand IV: the communication and visibility part of the project (NIGZ/EHN and strand holders) is aimed at the expansion of the project. The 6th IUHPE conference in Stockholm, June 2005 will offer an opportunity to integrate the work of the different strands, present the results and consensus on instruments, to involve new parties and to lay a foundation for a second phase. The deadline for abstracts is prolonged till 20th October 2004. Project participants are invited to submit abstracts from their work and are free to consult with their strand holder(s) in doing so. Round of introduction participants In an interview round, Jan Bouwens asks attendants for a brief reaction to his questions with the following results: HDA, England (Maggie Davies, Antony Morgan, Jeff French) explains in a nutshell how they get evidence into practice. It is twofold: concentrate on the big killers or focus on way of working. Firstly, they try to find out what’s going on: evidence based. Secondly, working out what to do with evidence: making guidelines, setting standards towards government. Focus is on different stakeholders: analyzing and dissemination. Implementation of health promotion is not done, for effective practice it means assisting in what is effective. Potential problem is that it seems focused at practitioners, but one should also look at policy framework, look for support there. Challenge is to move to policy areas.


Practice into research needs developing methodology, looking at the present practice, learning from practice, looking critically at the traditional ways. Exp.Centre for Health Education, Italy (Giancarlo Pocetta) offers experience and research in quality criteria. Mr. Pocetta sees room in framework of strand III to working with professionals and academics to create quality criteria. Estonian Union for Health Promotion (Dr. Mai Maser) assists in health promotion projects, building and developing different strategies. They participate in GEP project looking for practice and guidance. In Denmark (Institute of Public Health, Christine Stock) the main areas of health are obesity, heart diseases, alcohol, health in young people. The Danish National Board of Health (Mrs. Brigitte Gade Koefoed) is working on a national plan on the topics of obesity and alcohol. They are busy collecting evidence and this project is an incentive to move on. The role of the EuroHealthNet (Caroline Costongs) in the project is to establish contact, trying to get results and make sure that not-on-board partners will join. EHN also looks for possibilities to continue the work after this 18-month-period, e.g. through ERA-Net. International Health Development Research Centre in Brighton, UK (Caroline Hall) expects – during these two days - to hear more about the project and finds exchange of information vital. For Mme Christine Ferron from French Institute of Prevention and Health Education, quality assessment is an issue in this project. They are building a group of experts with a good knowledge of documentation, resulting in one set of guidelines of quality criteria for educational material (which is not easily accepted by scientific committee). At present, INPES is at crossroads. Scotland is represented by two institutes: Mrs. Shirley Fraser is working for the Learning network sexual Health and Wellbeing in the evidence area. Sex is not easily talked about in Scotland and she has to manage all questions like how and what, aiming at practitioners. Mrs. Erica Wimbush from Health Scotland has a role at more general level, merging public health with health promotion at organisation level, bringing together the implementation side with the information side. The two cultures are starting to develop strategies, bringing practice into evidence. They are also working on policy strategy. Vivian Bos is having her first day at work in the NIGZ, learning all about the project and meeting the participants are her primary interest. She will participate in Strand I. Catherine Jones, IUHPE, reports that Strand III is working on four topics: mental health and tobacco (dating back to 1999) and policy and infrastructure which are selected for relevance as a result of an ongoing process at global level. Dr. Eva Jané-Llopis (Radboud University), author on Mental health relates that mental health is not enough on the political agenda, prevention in this area is led by psychiatrists. She will try to mainstream mental health into the health promotion stream. She has set out a course to identify what is evidence. She feels good about linking up with this project. Health Promotion Switzerland (Mrs. Ursel Broesskamp-Stone): although their country is not a member of the European Union, they are nevertheless interested in this project. Their institute Is a member of the IUHPE and EHN network. Being located right in the centre of Europe, they relate in health promotion to other countries and leave politics to other institutes. Yvonne Eckert, replacing Mrs. Saloma von Greyerz from the Swiss Federal Office of Public Health sees the need of working together, with other countries. From the meeting she hopes to find more clarity of her role (as partner). Mrs. Marina Grichtchenko represents Prof.N. Klazinga from the Dept of Social Medicine in Amsterdam, who evaluates the project. She requests the participants to fill in the questionnaires after the meeting for the purpose of evaluation. Mrs. Arja Aro, strandholder Strand I feels that already a lot is happening. Her Research Institute KTL, Finland, produces knowledge for evidence and advises to the political level. The work (carried out together with Sanna Räty) is both fun and a struggle, messing up all the concepts of defining evidence. Stephan Vanden Broucke (Flemish Institute for Health Promotion (VIG)), strandholder Strand II emphasizes that capacity building is an important issue in the project. It was planned in the original proposal and it is necessary to start looking at availability of capacity building in building evidence. VIG/NIGZ (Tom Vermeulen/Henriëtte Kok) are complimentary and have found consensus in their work in Strand II. First, they put all the criteria in clusters, worked on the consensus and then put all the information into the database (which will be presented during this meeting).


Irena Pirktina from the Latvian Health Promotion Centre gives an update on how their public health institute is organized. It is a process from practical state (implementation) into production of guidelines in a protocol. She feels good about taking part in the GEP project. Hanna Drahanovska from the Czech National Institute of Public Health is working on co-ordination and is in close contact with practitioners, at the same time advising her employer. Mrs. Zora Gerova is working at the Public Health Institute of Slovakia, which organisation has a broad scope of activities: hygiene, environment, epidemiology, microbiology. Her Department, Health Promotion, was re-organized in 2003, now having 10 professional workers. Main health problems in Slovakia are non-communicable diseases such as cancer, cardio-vascular diseases. They concentrate on educating the population in lifestyle factors, step-by-step, as it is difficult to make changes because of social pressure. Plenty of health community centers, but there is a low level of trust because the political system is not facilitating health promotion. The Slovakian Regional Authority of Public Health (Mrs. Maria Avdicova) has a programme which demonstrates measures of effectiveness of evidence. She will use the guidelines from this project. Dr Viv Speller, freelance consultant and author in Strand III sees added value of this project in a number of ways. The tension between clinical/medical and health promotion is evident. The project is a step forward in bringing practitioners and researchers together. Capacity building should upgrade low levels in Europe. There is the issue of ensuring the existing evidence from practice. The process needs to release results from local/regional practitioners. Nina Parry-Langdom joins the meeting from the Welsh Assembly in Wales, UK. She is used to working in a challenging health promotion field that is both chaotic and dynamic. Mr. Volker Stander from the Federal Institute of Health Promotion in Germany is eager to hear all that will be discussed in the meeting. Hans Saan, senior advisor in the project at NIGZ, thinks it is not possible to reach consensus by commenting on the process. There is a lot of bureaucracy and progress in the field depends on disagreement. In meeting resistance it is clear that the issue is important. He advises the meeting to look for common grounds and enjoy the differences. STRAND I Presentation by Sanna Räty on the Review Protocol In advance of the meeting all project participants received the updated working plan (annex I) and progress report (annex II) of the Review Protocol. The presentation has been printed and distributed in handouts. The aim of the strand I REVIEW PROTOL is to develop a consensus based review protocol. The work already carried out in Strand I so far consists of:

- Creation of the network (involvement of project team members and partners) - Creation of the conceptual map - Data gathering consisting on survey on review protocols and quality criteria and searching

data on existing review protocols. At the beginning of the working process a tentative conceptual map on collecting and defining/analyzing the evidence in health promotion was developed to clarify the concepts and their relationships. Data was gathered by a survey among the project team members and partners on review protocols and quality criteria, and by searching data on existing review protocols (literature search). The survey was sent out to the project team members and partners; 15 contributions (out of the total 19) were received.

Conceptual map as well as the preliminary results of the survey were presented. In addition, existing review protocols designed for HP/PH or used in HP/PH topics were presented. The more precise analysis of the existing review protocols is to be started within the next few weeks. Participants discussed in groups the following themes in Strand I: 1) technical aspects; the conceptual map, the review protocol list and the key issues in collecting and analyzing the evidence in HP/PH. 2) practical aspects; the role of the participant(s) in the strand I work; their personal strengths and weakness (challenges and opportunities) in working with the strand; involving the project


Feedback from the four groups (in plenary) 1. Technical aspects A) Conceptual map:

- t was recommended to limit the scope of the strand I: focus on effectiveness only and evidence on health determinants.

- It was recommended to edit the conceptual map; - It is important to bring information from Strand II into I to answer questions at the bottom of the map (how to find and classify information from practice and individuals) - Replace ‘evidence’ by information/knowledge - Reorganize the typology/ ranking/hierarchy (research-documents-practice-individuals): for example a flow charter on Delphi model was recommended - Clarify language; needs to be understandable at first sight. - Include the context in which the review question is asked: why evidence is needed; what is the

evidence question? - It was also suggested to think how useful the map would be for next steps. In addition it was

asked to pay more attention to grasp other forms of evidence than research. B) Other comments:

- There are several issues needing to be included: health impact assessment, health equity, jurisdiction, and economics (HIA/IIA/EIA, community profiling, health equity audit).

- Advice is to take a concrete topic rather than starting a review protocol in general: Example of a topic to test protocol and then generalize, then ask those who produced them, and how useful they are.

- Use flow chart to identify appropriate models taking people through the process of searching evidence.

Reaction from the strand I holders: A tentative conceptual map will be further developed according the comments received. In addition the more general comments will be taken into account when planning the next steps of the strand. In addition participants were asked to give feedback by email on the subjects, which were not discussed at the meeting. For instance: is the review list presented at the meeting sufficient? Do we need more information on different review protocols to be able to achieve consensus based review protocol, for HP in the Europe? Comments were asked to send by mail to Sanna Räty ([email protected] ). 2. Practical aspects: A) comments on opportunities and challenges

Challenges: - lack of expertise in search and collecting evidencepoor research/evidence culture - lack of time and money/context - systematic use of protocol - no access to tools/instrument - lack in common language - protocols are part of training Opportunities - good contacts in the field - everybody will contribute to and affiliate with the work - communications/summary/information is very important - Ability to use different sources. - Strength in using different source


Project team members and partners were willing to contribute to st rand I work. They listed their assumption on their roles in strand I work:

- Contribute to the process - Act as a reflection group - Play an active role in Delphi method - Assist in consulting broader professional network in countries - Take part to the testing of the protocol - Take part to the dissemination - At a later stage: offer training and let new partners take part in Second Phase (GEP II).

Instructions were given to the co-ordinator:

- Divide tasks: coordinator should delegate more (smaller) tasks to the project team members - Enhance communication: make sure people want to be in the Evidence Consortium (use

Newsletter – website) - timing is important in involving other partners

How to enhance work:

- keep strand meetings together - strand leaders should keep in close contact and identify the links/opportunities - just FYI is not enough, meeting discussions are also necessary.

STRAND III presentation by Catherine Jones, IUHPE Catherine is thankful for the opportunity to take part, share thoughts and prepare the planning of the publications. Her aim is finding more evidence for Health Promotion effectiveness and defining the state of the art with IUHPE as strand holder. Strand III is linked to two multi-partner projects:

- Project Getting Evidence into Practice - IUHPE Global programme on Health promotion Effectiveness, consisting of 7 regional projects

with a variety of professionals/institutional partners. The aim of the global programme is to - review & synthesize evidence of effectiveness of interventions - translate evidence for policy makers, practitioners - stimulate debate on how to enhance quality and effectiveness. All strand leaders are strongly in agreement with the significant need to synchronize the processes of the strand III authors with the work of the two other strands. It has been identified that the work on mental health and tobacco control have strong links with strand I and that the work on infrastructures and policy have strong links with strand II. There will be a total of 4 papers on Health Promotion Effectiveness in Europe : - Tobacco control by Karen Slama, International Union Against Tuberculosis and Lung Disease (annexe in conference package). - Mental health by dr. Eva Jané-Llopis, Department of Clinical Psychology & Personality, University of Nijmegen (presentation at this meeting). - Health promotion infrastructures by Spencer Hagard, London School of Hygiene and Tropical Medicine in collaboration with Maurice Mittelmark, University of Bergen. - Evidence into practice: creating change and capacity building by dr. Viv Speller (presentation at this meeting), independent consultant, England in collaboration with Antony Morgan, HDA, England. Strand III sessions are structured around the content of two of the chapters of this publication on effectiveness in health promotion. Lead authors look forward to meeting participants and partners in strands I and II, present outlines for their manuscripts and seek feedback on the integration of the review methodology (for mental health and tobacco control) and the quality indicators (for infrastructure and policy) which are of high importance to further the writing of their papers and ensure coherence for all GEP deliverables. The (IUHPE) process is guided by the following principles, being that all content will… - be described in relation to the contribution each would be making to health promotion; - address the analysis of effectiveness through the health, political, social and economic outcomes, remaining consistent with the original European work and approach;


- use the expertise at all levels through a process of exchange and feedback from specifically concerned sectors including: policy, practice, research and communications. Things to consider are: - how to incorporate the learning from the strands into the papers’ content? - how can closer collaboration between all three strands serve to enrich discussion on issues like search processes, levels of evidence and consensus, and quality criteria for all three strands? - how can this process best be organised to ensure mutual, two-way feedback. Catherine Jones concludes by saying to corporate the learning from today’s discussion into strand III, organizing communication to make it beneficial. Presentation Dr. Jané-Llopis (author in strand III) on the background a review on what works in Mental Health Promotion (MHP) (chapter to be published). The issues to cover are:

• major reviews to date in Mental Health Promotion • the MHP review for GEP • how to present the evidence? • links with strands I and II

In a special issue of the IUHPE journal Promotion & Education an article will be published (in the frame of the Global Programme for Health Promotion Effectiveness) entitled: What works in MHP: strategies for action. Dr. Eva Jané-Llopis refers to a database (www.IMHPA.net) on programme and policies MHP in Europe (from other projects), as well as WHO Reviews on Evidence based programmes and policies. The aim is a Europe approach to ‘expand’ the term evidence. The chapter outline is as follows:

• Introduction to the European scenario • Introduction to evidence for mental health promotion in its broader scope • Methodology • Review presentation: - Settings approach; Health, social, economic benefits • Principles: implementation, sustainability

The methodology until now for Promotion & Education (global programme): • Systematic literature reviews (for some topics) • Expert knowledge – personal contacts

For GEP (linking with strand I):

• Published reviews (IUHPE; WHO) • Reviewing the grey literature through partners (e.g., Imhpa project: practices template) • Quantitative – qualitative information • Focus only on European examples

On the question on how to present evidence • Efficacy – effectiveness – cost benefit • Different types of evidence, but how do they relate to each other? • How should the different evidences be presented?

Question: how is this approached in strand I and II Other evidence indicators are

• adoption of best practices does not guarantee success: need quality implementation (Type III error)

• programme fidelity-fit local needs, guidance, training, supervision, quality of delivery (barriers) • sustainability; accountability (ownership, transparency)

Question: How is this approached in strand I and II? Questions for discussion: What does one do once all the evidence is completed? Has all the evidence the same weight? How does one make distinctions in presenting the evidence? How does the mental health chapter link with the examples that will be undertaken in strand I using the developed methodology? Mental health in your institutes, how would MHP links with Strand I on country level. Comments from the discussion: Tension in the publication needs to be avoided, reviews are in the field of MHP. Methodology can improve Second Phase of the project.


Advice: rethink the abstracts for workshop in Stockholm conference 2005. In terms of interacting, testing, more cross strands work. Coalition: a first step would be collecting information through different systems. Questionnaires need to be filled in on country level, and the leader has to look for alliances. It is difficult to identify who works in Public Health. Mental health is not included in Public Health, especially so in the accession countries. Closing observations after DAY I by Hans Saan In observing the presentation and discussion during the first day of this meeting, Hans Saan sees how this project faces very well the challenge to bridge the research, policy, practice gap. This GEP project meeting is about ambition and capacity for this project, all wishes can be projected to the Second Phase. From experiences during 4 Dutch national conferences about research (www.newhealthpromotion.nl), he advises to look beyond the evidence. He presents a model of the process from data to information, to knowledge to wisdom. These two days are about how to walk cleverly that upgrading and what to include and what to exclude. He proposes to focus on social interventions and exclude the bio-technological stuff. He refers to the Ottowa Charter, which should be kept in mind for this project in all the work. His leading motto for today is: EVIDENCE X USE = IMPROOF policy practice, research >> HEALTH. Both proof and improving is our aim. Four parties are involved, the general public and a triangle of research, policy and practice. A circular model of ongoing knowledge management shows: develop knowledge, share it, reflect on it and use it for the next phase. This is not only done by researchers, but all parties develop their own knowledge, the art is to use it all or combine. Researchers codify their knowledge and reduce their perspective. Hans Saan talks of building a distillery in which to judge, review and collect (evidence process). He even suggests to go backwards in this knowledge process and offers two feedbacks to research: getting more relevant research implies more attention for the dynamics, the context and the role of partners. The second feedback: help to make the implicit explicit: be critical of the official stories and unvale what goes on in the fuzzy processes. All parties at all stages have a relevant role in the process of making sure that the knowledge process works well. DAY II Friday October 1, 2004, 9.00-16.00, Location: NIGZ, Woerden the Netherlands General items:

• HDA advertises CD-rom and publications • KTL distributes a copy of article in JECH (Journal of Epidemiology and Community Health)

Online: a glossary for evidence based public health, by Rychetnik, Hawe, Waters et al. • The evaluation form (in the conference package) has been changed and is distributed with the

request to send it to the AMC after the meeting. Presentation of the newly designed website : www.nigz.nl/getting evidence by Jan Bouwens. Instructions on the use and purpose of the website are included the conference package. Each institute has its own LOGIN username and password to enter the protected area of the site. For technical reasons NIGZ is webmaster and has only authorisation in placing and/or deleting files, documents, etc. Participants are requested to send comments, documents, attachments etc. to the GEP secretariat in Woerden. Questions and other communication concerning work within the strands can be directed to strandholders directly through emailing. Project participants are requested to link up with the project on their own websites for interested parties to visit the public section of the site. 6th European Conference on the Effectiveness and Quality of Health Promotion: Evidence into Practice , Stockholm, Sweden, 1-4 June 2005 Mia Danielson, working at the Research department at NIPH in Sweden, gives an update on the preparations of the conference. The deadline for abstracts has been prolonged till 20th October 2004. Focus during the conference will be on Evidence for practice by improving the knowledgebase for health promotion and public health policies. Themes are evidence for effective practice for equity in


public health and health promotion. The aim is to work practically and effectively through integrated health promotion settings of daily life and life style interventions, particularly in the following arenas: workplace, health care and community development. The preliminary programme of the conference will start with opening on Wednesday June 1, by the Swedish minister, John Davies and M. Kokeny, followed by plenary panels. Thursday morning June 2 is reserved for Evidence into practice (from the GEP project) by way of a keynote address (David MacQueen will be there), posters, parallel sessions (max. 8) and workshops. The afternoon is dedicated to Workplace Health, Friday June 3 is reserved for Health Care (in the morning) and Community settings (in the afternoon). Saturday June 4 is closing with poster sessions and a keynote summary, followed by a social programme in the afternoon for those staying overnight. There will be no second announcement by way of publication, developments in the programme will be published on the website: www.bestpractice2005.se. Workshop strand II GEP: presentation Development of a consensus quality assessment tool Introduction Strand II is concerned with the development of a consensus based quality assessment tool (QA-tool). This tool should help health promotion practitioners to improve and assess the quality of their projects. Subcontract holder of strand II is the Flemish Institute of Health promotion (VIG), Belgium, with Stephan Van den Broucke as strandleader. Project co-ordinators are Tom Vermeulen (VIG) (till 1st of October 2004), Caroline Bollars (VIG) and Henriëtte Kok (NIGZ). Strategic aims For strand II we had outlined three strategic aims: 1) An inventory of assessment tools that already exists in and outside Europe, e.g. Preffi and PK+.

This inventory has just been finished and in this presentation we will give you the results. 2) The second aim is reaching consensus on an assessment tool that we are developing in the next

phase (October till January). For this development we will use the inventory. 3) The third aim is to pilot test the agreed developed assessment tool on a number of projects. That

will be done from January 2005 - June 2005. Procedure Data collection To conduct a review of existing assessment tools, five search strategies were used: 1) a systematic review of literature databases with searches in 4 databases (e.g. Medline). 2) a second search strategy was an internet search via frequently used search engines (e.g. Google,

Metacrawler). 3) consulting project team members and partners of the project “Getting Evidence into practice” to

provide complementary information. 4) searching websites of relevant experts, institutes and organisations, also outside Europe, who

have experience in the field of quality assurance and quality improvement (e.g. CDC, Kahan & Goodstadt) and consulting them.

5) finally, a “snowball strategy” was executed, using cited references of the literature found. Inclusion criteria & exclusion criteria The inclusion criteria for the selection of publications were that the publication should focus on the application of quality in health promotion projects. The Ottawa Charter was used as a starting point of the review. Every publication written before 1986 was excluded. Exclusion criteria were: 1) a focus on health care and health services 2) a focus on outcome measurement e.g., quality of life; a biomedical perspective 3) focussing on illness and disease 4) publications that focussed on only one specific setting, e.g. education, workplace 5) publications that dealt with the quality of evidence and the development or presentation of a

review protocol 6) publications that handled solely on evaluation.


Descriptive analysis The found data were divided in three categories: • QASA-tool (quality assurance self-assessment tool): instrument containing concrete criteria and

items that can be scored or checked for. • Guidelines: less concrete. They give recommendations. Contrary to the tools, no scoring or

checklist is provided in guidelines. • Registration system: mostly used for the documentation of a project in a database. To describe the tools, guidelines and registration systems a framework was developed. For this purpose, three dimensions were identified: content, technical and scientific. 1) The content based dimension contains information on the specific target of an instrument, the

target group, the theoretical underpinning (e.g. is the tool theory based: planning models, project management)

2) The technical based dimension gives information on the development: who is the developer, who has the copyright, when is it developed, in which language is it written. Also the number of items and clusters of a tool were described here.

3) The scientific dimension describes the different evaluative characteristics of an instrument. It was described if a tool is evaluated on user-friendly-ness, effect or process. Also we assessed if a tool was tested on validity and reliability.

Qualitative analysis A qualitative content analysis of the quality criteria of the tools only for QASA-tools was conducted. All criteria (items) of the different tools were listed in an ACCESS-database, there were in total 600 quality criteria. These 600 criteria were re-clustered, taking the different criteria as a starting point. Re-clustering was done both independently. Identified clusters were compared. In a internal meeting consensus was reached. The result was 15 clusters and one rest category containing criteria not belonging to one of the 15 other clusters. Next, the data were reduced by eliminating overlapping criteria and adding clusters together. After this step,10 clusters remained. Results Sample In total 15 QASA-tools, 27 guidelines and 8 registration systems were included. Also 67 references (e.g. background information, principles, guidelines) were found. Descriptive analysis English is the main language for QA-tools. Tools take different forms. Most of the tools use a scoring form or a checklist. The number of criteria to be assessed ranges from 17 to 119. Validation-studies on the tools are rare (n=5). Qualitative content analysis The coding process and subsequent synthesising delivered 10 clusters. These ten clusters are: preconditions, capacity and resources, communication and participation, analysis, target group, objectives, planning, intervention, implementation, diffusion and continuation and finally evaluation. Discussions following presentation Strand II The following discussion points were discussed in subgroups and the following results presented plenary: Subgroup 1: Further synthesis Discussion points What will be the core criteria of the European tool? • List of 344 criteria → ?? list of criteria • What is the best logical structure of clusters and criteria? • Are clusters and/or criteria missing? General comments 1. Logical ordering of the clusters: traditionally these are time-sequenced, but do we want to change

this? For instance, why does evaluation always come at the end? A result is that HP-professionals do not think about properly.

Verwijderd: ¶


2. The present review is retrospective, but we want to include new important areas that the current practice is missing: • evidence informed practice • user perspective on quality • programme theory of change

3. Who is this tool meant for? At what level should this tool be used? More attention should be given to the users. Who are we expecting to use it?

4. Strengths of the consensus based QA-tool: • the scientific process of strand II which reveals what are the 10 key principles/competencies of

best practice in HP • developing a tool that can be used for performance/ quality assessment purposes, not solely

based on evidence basis 5. User participation needs to be involved in the validation process – but who are the users? 6. The QA-tool developed in strand II needs to be combined with the protocol developed in strand I. Recommendations group 1: A core set of clusters to which people can add for the focus: 1. Preconditions: important but rename 2. Capacity + resources: ok 3. Combine communication and dissemination 4. Participation should stand on its one and cover both user & target group participation and

stakeholder engagement 5. Analysis: rename this in e.g. needs assessment or assessment of needs & assets 6. Planning: this cluster should also include target group & objectives. Add an extra item for the

planning of evaluation. 7. Evaluation: this might include intervention design (which means thinking of change mechanisms,

theory of change, program theories) 8. Implementation: should be a cluster of itself. Delivery & support & training. 9. Continuation and sustainability: too technical. Choose one of the two terms as they are

synonymous. Subgroup 2: Form of the instrument Discussion points • What kind of scoring do we want to use? • How can we make a tool suitable for agencies/ regions/ countries that differ in capacity? • Can we use the database as a starting point? What kind of scoring do we want to use ? Look backwards and start with thinking of for whom you develop the tool. Than decide which scoring you want to use. Therefore to give concrete recommendations for the scoring type is too difficult in this stage. General recommendations: The best scoring method is a method that is very easy to use. Make it as simple as possible but not too simple! 1. Be creative and look at existing tools (self development tools, self assessment tools) for scoring

possibilities. 2. Use a cyclic way and easy navigation. 3. A wide range of questions means incorporating a mixed range of scoring possibilities.

(dichotomous items as yes/no, range e.g. the Likert scale, open ended questions) and a different level of details.

Specific considerations Who is going to use this tool: link to MARKETING; what should be the consideration for the format? • differentiate users for the suitability of the tool • crucial national and regional focus

Scoring WHO?


• design elements: - user-friendly - user-specific - customised options

• potential vehicles for marketing (inter-sectoral reach) - university and master programs - national funding agencies - professional networks (IUHPE, EuroHealthNet)/ accreditation - European commission

Can we use the database as a starting point? YES. The database must be used and put on the website. In this way we can maintain the link with the original tools. It gives the possibility for interaction and transparency. Subgroup 3: Guidelines Discussion points • What does a guideline mean for you? • What is the most important added value of guidelines? • How detailed should we analyse the guidelines? General comments • Other elements of the tool should be analysed as a tool is richer than the criteria it contains. • More information is needed on how to use the tool and on what questions it gives an answer. • Is everything included in the tool? • Whom is the tool for? Policy, practice, people who commission? Place of the new tool and the existing tools • The richness of existing tools should not be lost, so:

1) develop a simple tool and keep the richness in the existing tools, or 2) develop a new tool and incorporate the richness of the existing tools The new tool should be a

core tool in Europe. • What will be the place of the new tool in relation to the existing tools? Is it a replacement or is

there still room for existing tools? • Note that countries which already have a tool might be aversive to use a new tool. Other count ries

however might prefer a new tool. Added value from the guidelines Choices should be made. It is good to look at the guidelines, but on the other hand this can make it broad. Long term strategy A long term strategy is needed. The Evidence consortium should work long term in stead of in phases. This long term strategic planning should be discussed during the EuroHealthNet meeting in December. Is there overlap between QASA-tools and the guidelines? Make a comparative analysis on the remaining tools and guidelines. Next, you can decide how to deal with overlap. Inclusion and exclusion criteria People have two weeks (deadline 15th October 2004) to give additional tools to Strand II. Tools sent later will not be included, but presented at the Stockholm conference and compared with the developed consensus based tool.


PRESENTATION STRAND III, by Dr. Viv Speller, author/consultant on the Evidence into Practice chapter Introduction by Catherine Jones stating that it is interesting and necessary to compare the text of strand III authors ‘against’ the available review list/quality criteria for insights gained from the two strands and organise mutual feedback. This is the idea not only during this strand meeting, but also true for the further course of the project. This should be done in a way that is feasible and reassuring for both authors and strand holders. The chapter IV theme of Evidence into Practice was selected over a a strict policy focus as it represents a greater challenge, responding to the need for guidance in order to make evidence based changes in the delivery of public health. Major aspect of this chapter's content will be derived from a cyclical process of deriving evidence, producing practical guidance based on it, identifying change pathways and supporting practitioners and others in public health systems to make evidence-based changes, collating evidence of effectiveness from practice, and then updating the evidence in line with practice as well as new research findings, and so on. In presenting the outline of chapter IV, Dr. Speller seeks feedback from both strands, hoping for a fruitful discussion about topics such as search processes, levels of evidence and criteria for quality for the three strands. The outline of the chapter includes the description of English case study: HDA Evidence into Practice cycle with a summary of progress on producing evidence and guidance, developing practice and learning from effective practice. From literature reviews is presented what is known about effective ways of supporting change in individuals and organisations; system and complexity theory (HDA publication and presentations in Melbourne 2004). Other issues are the capacity-building processes and practice development with further case study examples. The chapter will be concluded with recommendations for processes for getting evidence into practice. Dr. Speller describes the chapter is a passive resource, but a pre-step of what is to come. She presents a model of the Evidence into Practice cycle, drawing together learning from project phases into overall systems and thinking beyond the evidence. They have looked at two pilot projects with different topics, went through the process of appraisal of plausible recommendation and resuming suggestions from practitioners, leading to Effective Action Briefing. Researchers found out what is been done in practice and created an own database. Dr. Speller presents the methods (for details see handouts), concluding that it is mostly about better communication. She feels that the work relates to strand II as it fits with the registration system. The intention is to develop a system to enhance and enrich public health practice; a standard for and increasing certainty of effective practice; a national planning tool. The work in strand III yields to update the map and helps to produce guidelines based on practice. Question is: can practised form of evidence actually help? They looked at evidence across individual systems. It needs recognition of bringing change to existing systems and should be more included in the other strands. Context with the GEP is the health promotion infrastructure (chapter II by Dr. Spencer Hagard) which will be to focus the review of the overall system of health promotion in Europe upon 8 areas: formulation of hp policy, high level evaluation of hp policy, regular systematic monitoring and regular reporting, survey and research capacity and knowledge development for hp, implementation, professional workforce, professional associations and funding. The difference between practice and policy in phrase and understanding is pointed out in the discussion that follows. Chapter IV will provide a baseline. Important issue is capacity building. Key components in other countries to start up activities are not to be underestimated. It is necessary to get practitioners to record their efforts. Data need to be recorded in the database systematically, but updating will require time and money. There is a request for a draft set of criteria, drawn from literature on effective practice. It is noted as an interesting chapter bringing strand I and II together but the involvement of other strand project team members is unclear. Dr. Speller points out that this presentation was meant for feedback, she plans to send around a draft of the chapter for comments (to project members and other experts). The draft is expected in February/March 2005, but it is suggested to send it around before Christmas 2004 as the input for all four chapters has to be ready before the Stockholm conference (June 2005). The results will be published in a special edition of the IUHPE (global) Journal Promotion & Education, followed by a sequence. There will also be a special section for articles from Strand I and II, plus an editorial.


Rapporteurs’ report by Hans Saan Based on his observations he states that the project has managed to build on best sources available so far. However, the project also needs to be prepared for the future. So, focus also on the purpose of our instruments and by whom they will be used. The instruments at the same time mirror AND shape the professional work. If Hans has to check instruments on being future proof, he will look for:

- What are the implicit theory and principles: various countries have varying ideas on health promotion, a guidance on theory may be necessary;

- Sensitivity to context: are inward and outside looking elements provided. - Is sustainability addressed: Look beyond a single project, we are all a part of a chain - Co-operation with many partners (public, intermediaries, policy/politicians) needs to be done in

several types of languages - Project members have to be ready to cope with chaos, handling complexity.

Hans Saan refers to the model of knowledge also shown the day before: even is there is a promising intervention package (school materials, group work protocol) that seems to be copy-ready, even then a tool (checklist) to help re-invention is needed. The usage of the tool:

- before = invest (preparing and planning) - during = scan (process optimalisation) - after = proof (audit)

Mainly the practitioners will use this tool. The tool requires competency and capacity and will be used under varying working circumstances. The tool must not be an instrument blaming the professional. Management has to sustain the use of the tool. In conclusion:’ to enhance the quality of Health Promotion, we need a tool, we need an guide how to use it, but we certainly need leadership; people who are ready to serve and lead the public, who are strong on advocacy; who are ready to struggle with the plans made; who can act as if they are in control. And all that on both sides of the brain. A challenge to be included in the next phase ‘. Closing address by Jan Bouwens Jan summarises some conclusions and looks to the future. He is impressed by the work carried out beforehand and during this two-days-meeting and by the human capital involved. He senses a keen involvement and a promising combination of experienced senior researchers/consultants and the upcoming generation in the project. Halfway in duration and with a limited budget, the project offers a big challenge, but needs be balanced in ambition in management and feasibility. For the consensus (next) phase and testing plans, clear choices need to be made. Comments from this meeting, some quite substantial, will be taken into account. It is needed to be more explicit in what actions and steps to take and what to exclude. Topics will be discussed in the Steering Group and communicated with members and partners. It will be a challenge to synchronize the working process between deliverables in strands I, II and III. The model and protocol Strand I is working and offers a scientific base/evidence base. In one way or another the deliverables in Strand II need to be integrated in the mode of strand I. Strand III has proven to open windows towards harmonize the working process. For the Stockholm conference it is important that the project is presented as ONE, at least in format and ideally in contents and deliverables. There is a need for shared information and context. In the keynote address the strandholder will scetch the European experience and results on getting evidence into practice. David McQueen will reflect on this from the global perspective. At present, some abstracts are in preparation for presentation in (interactive) workshops, as showcase, discussing the instrument and topics of the update review and actual hand-off experience with the instrument. Another topic for a workshop is capacity building and a European work programme on health promotion. Ideas for abstracts for inter-strand-presentations are welcome.


Report on the results from the Steering Group meeting (29th September 2004). Communication:

- The website and newsletter (yet to be started) will be supportive elements - A submission for second phase grant with the European Commission will be written, deadline

March 2005. Focus will be on capacity assessment, capacity building and allocation of resources to accession countries

- The steering group is working on principles regarding storage and ownership data and publications and how to use information. A communication plan will be developed.

- Long term strategy plan will be developed Epilogue In using the metaphor of the project as an impressive sailing ship with many (international) flags, Jan concludes by wishing the project a safe journey, along Cape of Good Hope, returning in time to harbour at the docks in Stockholm with a lot of luggage to be presented at the conference there (June 2005).

Next Strand meeting with project team members and partners will take place in a two-days-meeting on Thursday 3 and Friday 4th February 2005, at the NIGZ in Woerden List of Participants Strandmeeting project ‘Getting evidence into practice’

30th September – 1st October 2004 In alphabetical order of country

Country/ Organisation

Name participant + email Institute Tel and fax

Belgium Subcontractholder Strand 2

Mr. Stephan van den Broucke [email protected] Mr. Tom Vermeulen (left office per 1 October 2004) Mrs. Caroline Bollaers [email protected]

Flemish Institute for Health Promotion Schildknechtstraat 9 B-1020 Brussels

Tel: +32 2 422 49 49 Fax: +32 2 422 49 59 Tel: +32 2 422 49 38

Belgium EuroHealthNet Communications

Mrs. Caroline Costongs [email protected]

EuroHealthNet Rue Philippe Le Bon 6 B-1000 Brussels

Tel: +32 2 2350 320 Fax: +32 2 23 50 339

Czech Republic Mrs. Hana Drahonovska [email protected]

National Institute of Public Health Srobarova 48 100 42 Prague 10

Tel: +420 2 67082548 Fax: +420 2 6731 02 91

Denmark (absent partner)

Finn Kamper-Jorgenson, director [email protected]

Danish National Institute of Public Health Svanemollevej 25 2100 Copenhagen

Tel: +45 39 20 77 77 Fax: +45 39 20 80 10

Denmark Mrs. Birgitte Gade Koefoed [email protected]

National Board of Health Islands Brygge 67; DK-2300 Copenhagen S

Tel: +45 72 22 74 45 Fax: +45 72 22 74 13

Denmark Mrs. Christiane Stock [email protected] replacing Evelyne de Leeuw [email protected]

Department of Health Promotion Research, Institute of Public Health (DHRP) Niels Bohrs Vej 910 DK-6700 Esbjerg

Tel: +45 6550 4115 Fax: +45 6550 4283

Estonia Dr. Mai Maser [email protected]

Estonian Union for Health Promotion Mustamae tee 4 10621 Tallinn

Tel: +372 51 35 396 Fax: +372 62 79 281 Tel: +372 51 05 621

Finland Subcontractholder Strand 1

Mrs Arja Aro senior advisor [email protected] Sanna Räty, project coordinator [email protected]

National Public Health Institute KTL Dept.of Epidemiology and Health Promotion Mannerheimintie 166 FIN-00300 Helsinki

tel +358 9 47 44 8264 fax +358 9 47 44 8338 mobile: +358 505603053 Tel: +358 9 47 44 8939 Fax: + 358 9 47 44 8338 mobile +358 44 303 1639

Finland (absent partner)

Mr. Mika Pyykko [email protected]

Finnish Center for Health Promotion Karjalankatu 2 C 63 FIN-00520 Helsinki

Tel: +358 9 7253 0300 Fax: + 358 9 7253 0319

France Mrs. Christine Ferron [email protected]

Institut National de Prévention et d’Education pour la Santé 42 Blvd. de la Libération 93203 St. Denis Cedex

Tel: + 33 1 49 33 22 22 Fax: + 33 1 49 33 23 90




France IUHPE Subcontractholder Strand 3

Mrs. Catherine Jones [email protected]

IUHPE 42 Blvd. de la Libération 93203 St. Denis Cedex

Tel: + 33 148 13 71 20 Fax: + 33 148 09 17 67

Germany

Mr. Volker Stander [email protected]

Bundeszentrale für Gesundheitliche Aufklärung Referat 2-25, Wissenschaftliche Untersuchun-gen, Qualitätssicherung Ostmerheimerstrasse 220 51109 Cologne

Tel: +49 221 89 92 330 Fax: +49 221 89 92 300

Greece (absent )

Prof.dr.Y. Tountas Mrs Christina Dimitrakaki [email protected]

Institute of Social & Preventive Medicine ISPM 25 Alexandroupoleos Street 115 27 Athens

Tel: +30 210 748 20 15 Fax: +30 210 748 58 72

Italy

Mr. Giancarlo Pocetta [email protected]

Experimental Centre for Health Education Universita Degli Studi Di Perugia Via Del Giochetto CP n 1435 06126 Perugia

Tel: +39 75 585 73 01 Fax: +39 75 585 7317

Latvia Mrs. Ineta Pirktina [email protected]

Latvian Health Promotion Centre 3 Skolas street Riga LV-1010

Tel: +371 72 4 04 47 Fax: + 371 72 4 04 22

Netherlands NIGZ Coordinating organisation

Mr. Gerard Molleman Project manager [email protected] Jan Bouwens, Project coordinator [email protected] Hans Saan, Senior advisor [email protected] Mrs. Vivian Bos [email protected] Henriette Kok [email protected] Marianne Smit, secretary [email protected]

Netherlands Institute for Health Promotion and Disease Prevention P.O. Box 500 3440 AM Woerden

Tel: +31 348 437 600 Fax: +31 348 437 621 Marianne Smit Secretariat Tel: +31 348 438 853 Fax: +31 348 437 666

Portugal (absent partner)

Mr. Pedro Ribeiro da Silva [email protected]

General Directorate of Health Alamada D. Alonso Henriques 45 1049-005 Lisboa

Tel: + 351 218430500 Fax: + 351 218430530

Slovakia Mrs. Zora Gerova [email protected]

Public Health Institute of Slovak Republic 826 45 Bratislava Trnavská 52

Tel: +4212 52961121 fax: +4212 52961124

Slovakia Mrs. Maria Avdicova, [email protected]

Regional Authority of Public Health, Banska Bystrica Cesta k nemocnici 1 Banská Bystrica 975 56

Tel: +421 484153261 Fax: +421 484123637

Spain (absent partner)

Mrs. Begona Merino Merino [email protected]

Ministry of Health Paseo del Prado 18-20, 28071 Madrid

Tel: + 34 91 5964194 Fax: + 34 91 5964195

Sweden

Mrs. Mia Danielsson [email protected] (replacement for Mrs. Carina Kallestal)

Swedish Institute for Public Health (SNIPH) International Relations Olof Palmes Gata 17 S-10352 Stockholm

Tel: +46 8 5661 35 15 +46 8 5661 35 00 Fax: +46 8 5661 35 05

Switzerland Yvonne Eckert [email protected] (replacement Mrs. Salome von Greyerz) [email protected]

Swiss Federal Office of Public Health Schwartztorstrasse 96 CH- 3003 Bern

Tel: +41 31 323 59 76 Fax: +41 31 323 8805

Switzerland Mrs. Ursel Broesskamp-Stone, [email protected]

Health Promotion Switzerland Dufourstrasse 30 Postfach 311 CH 3000 Bern 6

Tel: +41 31 350 04 25 (-04) Fax: +41 31 368 17 00

United Kingdom Brighton IHDRC

Mrs. Caroline Hall, MA BSc [email protected] John K. Davies

International Health Development Research Centre c/o Faculty of Health, University of

Tel: +44 1273 644168 Fax: +44 1273 643324




Regional vice-president IUHPE/EURO [email protected]

Brighton, Falmer, Brighton BN1 9PH United Kingdom

Tel: +44 1273 644169 Fax: +44 1273 644508

United Kingdom Health Development Agency (HDA)

Mr. Jeff French [email protected] Mr. Antony Morgan [email protected] Mrs. Maggie Davies [email protected]

Health Development Agency Holborn Gate 330 High Holborn London WC IV 7BA

Tel: +44 207 430 0850 Fax: +44 207 061 3390 Tel: +44 207 061 3011 Fax: +44 207 061 3394

United Kingdom Scotland

Mrs. Erica Wimbush [email protected] Mrs. Shirley M. Fraser [email protected]

Health Scotland Woodburn House Canaan Lane Edinburgh EH10 4SG Learning network sexual Health and Well being NHS Scotlan Clifton House and Place G3 7LS Glasgow

Tel: +44 131 536 55 88 Fax: +44 131 536 55 02 Tel: +44 141 300 1047 Fax: +44 141 300 1055

United Kingdom Wales

Mrs. Nina Parry-Langdon [email protected]

Research and Evaluation Branch Welsh Assembly Government Cathays Park Cardiff CF10 3NQ

Tel: +44 29 208 26 522 Fax: +44 29 2082 5779

STRAND III Authors and affiliated partners Dr. Karen Slama

([email protected]) International Union against Tuberculosis and Lung Disease, 68, Boulevard St. Michel, 75006 Paris, France

Tel: +33156802826 Fax +33156802820

Maurice Mittelmark Research Centre for Health Promotion University of Bergen Christiesgt 13 N-5007 Bergen

Tel: +4755583251 Fax: +4755589887

Prevention Research Centre Academic Centre for Social Sciences Radboud University of Nijmegen

Dr. Eva Jané- Llopis [email protected]

Head of Science-Based Knowledge and Policy Prevention Research Centre Academic Centre for Social Sciences, Department of Clinical Psychology Radboud University Nijmegen P.O. Box 9104 6500HE Nijmegen The Netherlands

Tel: + 31 24 361 26 67 Fax: + 31 24 361 55 94

Author/consultant Dr. Viv Speller [email protected]

Health Development Peacehaven, Uplands Road Denmead, Waterlooville Hampshire, PO7 6HE United Kingdom

Tel: + 44 2392 232 741

AMC Amsterdam (Evaluation of the project)

Mrs Marina Grichtchenko Replacing Prof.dr.N.S. Klazinga

Academic Medical Centre Dept. of Social Medicine P.O. Box 22660 NL-1100 DD Amsterdam The Netherlands

Tel: +31 20 566 4892 Fax: +31 20 697 2316


Minutes Strandmeeting, 3-4 February 2005 EC project no 20031123 (Evidence Consortium 790841) at the NIGZ, Woerden, the Netherlands Participants: see separate list of participants Opening Chairperson Gerard Molleman opens the meeting at 10.00 am, thanking the participants for coming and putting in a lot of work over the past months.There is a quick round of introduction with a special word of welcome to the newcomers Ms Catherine Swann (for Jeff French, HDA) and Mr Chris Brookes (for Maggie Davies, HDA), Stéphanie Pin (INPES) also representing her colleague Fabienne Lemonnier, Mrs. Christina Dimitrakaki (for Yannis Tountas), Mrs Marlene Läubli Loud, Maurice Mittelmark (for Spencer Hagard) and Karen Slama. The meeting pack for the participants includes the final program and handouts of the various presentations. Due to a last minute cancellation, extra time for reading has been reserved for later in the day. Molleman apologizes for the short notice mailing of the appendices of which printouts are available in the room. He refers especially to the appendix Evaluation report (see separate PDF file). In general, the responses to the report on the previous Strandmeeting were very positive on clarity and goals of the project as well as on scientific quality rated for the work done in the strands. Some respondents gave mixed reactions. Further evaluation will take place of this particular meeting and the project on a whole (after the Stockholm meeting). Contents of this report The minutes of this Strandmeeting are not in chronological order of events during the two days. First, we publish the plenary introduction by Hans Saan of his framework for reference. Secondly, we have put together the presentations and results on workshops and discussions per strand. Thirdly, we print the results of discussions on other relevant topics in this meeting, such as the Stockholm Conference and the application for a Second Phase of the project. We conclude this report with an epilogue with miscellaneous information. Introduction by Hans Saan: A framework for reference Hans Saan presents the

Knowledge Management circle, as earlier described in his article in the GEP Newsletter no 2. February 2005. The debate on the Randomised Controlled Trial (RCT) was discussed by Keith Tones, Don Nutbeam and others in 1997. That research debate was continued, but a broader look was necessary on how to use the knowledge. With support from government 4 conferences were made and Hans Saan and Willy de Haes are now working on a book. In shows the cycle Hans explains that development is done in practice, based on available knowledge. There

Health Issue

related

Processrelated

Conditionsand

context

USE SHARING

DEVELOPMENT

Plan, Adapt, Results

Practice

HP KNOWLEDGEManagement cycleHans Saan, NIGZ, 2004

Discuss,Meet,Publish

ReviewAdvice Synthesis Judge Collect

ImplementationAdoptionDissemination

REFELECT

EVIDENCE

QUALITY


should be collaboration between practitioners, policymakers and researchers to have broader awareness of what is going on in the field. Sharing can take place by meeting and publishing, then that information is the input of the review process. Result of reviewing is evidence and strand I focuses on that, its distilled criteria add to quality, to be summarized by strand II. Strand three will do review work on two topics, one article focuses on capacity, another on the full circle. There are two aspects:

- the red circle to make sure to run the health promotion processes as good as possible - someone is needed to help the wheel run.

Message for the GEP project: - do not look at the simple way, look at combinations - the project is already far and we have good ideas, but the managerial bit is the challenge. - In the end we all help the wheel running.

Discussion and comments: Mittelmark thinks the managerial aspect is too small in the model, what about training? He suggests to make it clearer how strand III is integrated in other strands. Hans has discussed capacity and managerial issues also with the Dutch Ministry: do they consider themselves as system or issue responsible? There are political aspects and the ‘game’ is also played at local level. NIGZ has great collaboration on local level and recently signed a collaboration contract. The goal is that NIGZ helps them to serve in practice, making sure that practitioner and policymaker have the same say in funding research. This may differ in other countries. Erica Wimbush observes that the evaluation of interventions is not mentioned. How to move from use to development? The answer lies in doing RCTs that include process and capacity issues much more explicitly.

Strand I: review protocol Presentation by Sanna Räty KTL Finland followed by discussion The main aim of the presentation was to give a clear picture on what had happened during the last few months.

• The first delivery of strand I is the inventory of existing review protocols. 16 review protocols were analysed using predetermined criteria. The analysing process was carried out by two independent readers. Sanna had worked together with research assistant Anastasiya Rogacheva (from Russia). The second reader, reading blind (i.e. unaware of the first reader rating) made an independent judgment on the same review protocol and wrote a short summary on the protocol to support the judgment process. The results of this analyzing process were ready by January 19, 2005, followed by writing the (draft) version of a report which will be sent to the project team members/partners for comments (in February).

• Other products of the Strand I are the conceptual map, which was further developed after feedback from September meeting into a more dynamic model, based on Nutbeam’s theory of health promotion and work by Hans Saan (such as the model/circle).

• Next steps will be finalizing the report on inventory of existing review protocols; future analysing quality criteria and writing a report on it; short (joint) article for the IUHPE journal Health Promotion & Education (together with strand II); four presentations at Stockholm conference. Strand I holds a workshop on Friday 4th February on the exercise of Delphi round I (see later minutes of this meeting). The Delphi rounds for strand I will be on March – May 2005.

Comments on the presentation:

1) Conceptual map: Future development of the conceptual map was seen very successful. It was good to use Hans’ model as a staring point and add also some other theoretical basis.

2) Inventory on the existing review protocols: A common European review protocol will be the end product of strand I. The comparison of the already existing review protocols was regarded as a good background work for this development process. However,


Anthony Morgan emphasizes that not all the existing review protocols are comparable. They are designed for different purposes. For example some of them concentrate only on synthesizing review level information. This is already taken into account in the analysing process and will be taken into account also in writing the inventory report. 3) Challenges for the consensus protocol:

• Morgan emphasized that there should be a theoretical approach to reach a consensus.

• Strand III talks about sources of evidence in the Infrastructure paper. Mittelmark sees possibilities for integration.

• Speller sees progress but talks of looking at two different windows, not being able to see all. Advice: Do not go far away from the existing protocols. Strand I needs to say: we have limits but…. She thinks that the produced protocol will be very useful.

• Standard protocol will be a powerful thing to be done. Questions were raised about trying to bring the strands together.

• Questions remain on how to pick up the change and not stay within the Cochrane only.

• Strand II needs to be purified and then later combined with other strands. Workshop Strand I Strand I workshop concentrated on the coming Delphi process. The workshop had two tasks:

1) Exercise and feedback on the use of the Delphi form 2) Discuss (and agree on) the

- material, - “do-ers”, - process

of the feasibility tests of using the review protocol 1) The workshop started with going through critical questions on the proposed structure of the review protocol.

• The group agreed to develop a review protocol for reviewers/experts (paying attention to end-users) when synthesising and /summarising on different levels of information.

• The structure of the proposed review protocol was seen OK with slight modifications. Hans Saan stressed the importance of good introduction chapter specifying the purpose, users and theory basis of the protocol. In addition it was suggested to emphasize that the step-by-step structure is only a technical way of presenting reviewing process, but that in practice these steps overlap and vary.

• A comprehensive list of sources of information was suggested. In addition to the published and unpublished information sources it was suggested to take into account also other sources of information coming from other fields than HP/PH. In addition it was suggested to start from the state of the art (already existing reviews). The idea of lists of national sources was regarded important. The dual role of experts was emphasized. In addition examples of search terms were regarded important.

• Phase ‘Selection criteria’ was changed into ‘Inclusion criteria’. Review question was seen as the basis of forming the inclusion criteria.

• Quality criteria of qualitative research were seen as a possible starting point for analyzing the quality of non-research (unpublished sources).

• Data extraction and synthesizing were seen important phases of the reviewing process.

• Reporting phase should receive a lot of attention. It was suggested to report the results in different (more land less detailed) formats. Morgan stressed the importance of availability of full reports

• Getting evidence into practice was also seen an important phase. Collaboration with strand III (Speller & Wimbush) was regarded important.


2) Feasibility test of strand I was suggested to be rather simple and modest in this phase. It was suggested that the project team members could interview experienced reviewers (n=6) about the usefulness of the review protocol. More precise instructions on the feasibility test will be delivered ASAP by the Strand I holder. In addition, there was discussion on how to expand the feasibility test for non-research areas.

Steps for the coming months:

• To be able to start the Delphi round I, project team members and partners were asked to send their feedback to the task by the 10th of February 2005.

• The actual Delphi round I will be arranged in March 2005 • Delphi round II will take place in April 2005 • The feasibility test will be in early May 2005. More precise instructions on feasibility

test will be sent soon after the meeting.

Strand II: guidelines (quality assessment tool) Presentation by Henriette Kok (NIGZ) and Caroline Bollars (VIG Belgium) followed by plenary discussion The strategic aims were: 1) to make an inventory of existent assessment tools of which the results were presented in September 2004, 2) reaching consensus on a quality assessment tool ( which was discussed in the working meeting on Friday 4th of February 2005), and 3) pilot testing the consensus based assessment tool (until June 2005), of which the results will be presented at the Stockholm conference. Henriette Kok explains the working procedures of the two Delphi rounds: - November 2004: 400 criteria + questionnaire were sent to the strand project team

members which yielded a good result: 11 of the 12 respondents returned the forms. - A framework for the changes was made: clusters were re-ordered, 4 main clusters and

11 sub clusters remained, 2 clusters were renamed, 20 criteria removed, 3 criteria added. Finally, 356 criteria remained for Delphi II.

The same procedure was followed for Delphi II. Caroline Bollars continues the presentation telling about the changes made on the basis of the feedback resulting into 126 criteria (final figure). One added criterion on empowerment was approved, some criteria changed in name. Future process: - to finish the draft (convert criteria into operationalised measurable indicators and develop

scoring form) - to reach consensus on the tool - procedure of the pilot testing (to be discussed on Friday morning):

o to select 2 participating projects per country o each country delivers 2 independent respondents o to apply the instrument on the selected projects

- to adjust the instrument on the basis of the test results - to produce a final version of the tool, after consensus has been reached.

Items for discussion: - form of the instrument (consensus on number, ordering and naming of clusters,

consensus on number of criteria) - further synthesis - operationalisation: formulation of criteria and the scoring form. Hopefully in 2007 it will be

a European tool. - Name of the new tool


Comments/discussions from the room: - Prioritize the 126 criteria, there are too many, the aim is that every one can use it. - Who will be using the tool for what? That has not yet been clarified yet. - Develop a web base as a solution? That is a lot of back office work. - What about the national tools? What is the added value of this particular European tool?

It is suggested that it can be used next to the countries’ own tool or the country can use elements from it. To discuss this a meeting will be organised in July with the owners of tools.

- It is suggested to introduce the tool in stages (like the Euro), let each country decide. - What is the updating procedure for this tool? - If used in project proposals, it needs to contain simple criteria for what needs to be done

in interventions (eg. in Eastern Europe). - Different use by different people at different levels. Think of use in small projects too. - What is the acceptability of this tool? So far, the database is used to indicate what system

is used in what country. - Is the tool transferable in different settings? - Developing a manual with instructions on how to use the tool.

Workshop Strand II: quality assessment tool Ursel Broesskamp-Stone Questions for discussion in working meeting Strand II: 1. Purpose of the tool and how it relates to evidence into practice 2. Name of the quality assurance tool 3. Number, ordering and naming of clusters 4. Reduce number of criteria 5. Operationalisation:

• Formulation of criteria • Scoring method/ scale

6. Procedure of pilot test • Selection of projects to be used • Method of scoring and giving feedback

Plenary report on the workshop Brainstorm results and decisions: 1. The tool will be for different target groups (HP professionals, policy people, national and

funding organisations). The tool can be applied for different uses. Although the criteria are related, one should be able to use them on itself, so the 13 criteria should be a tool on their own. So, a HP professional is not obliged to use all the criteria, but can use a selection.

2. No conclusion on the discussion about the name of the tool: several possibilities. Participants are requested to send in their suggestions. At least the following words should be incorporated in the name: • Health (promotion) • Europe • Quality • Assessment • Evidence


Strand III: More evidence for health promotion effectiveness Presentation Best evidence for Tobacco Control by dr.Karen Slama, International Union against Tuberculosis and Lung Disease, Paris Dr Slama explains the complexity of tobacco use in a social context, the individual variability and aspects of a smoking career and shows the health outcomes since 1950. She points out the economic costs of smoking and the political outcomes. Best practice for tobacco control are named in an estimation of effects: clean air policy at worksites; raised taxes on tobacco product and brief advice given in general practices. Effective tobacco control is shown in several slides. She names a number of legislative strategies, optimal measures to reduce prevalence and a number of policy recommendations provided within the Framework Convention on Tobacco Control (FCTC). Normative strategies contain social denormalisation (de-legitimisation) in creating an environment to facilitate healthy choices with possibilities for information and advocacy. Social perceptions are changing and programmes have been developed. Slama shows the smoking cycle from happy smoker to happy non-smoker. Best evidence research has been done through traditional studies and newer sources of information. Important are the communication aspects. She concludes by showing that health promotion best practices for tobacco control enables people to understand and take actions to change the determinants of their health. Comments and discussions:

- Brookes: how about poorer people, what measures for them? Denormalisation works for some and is stimulation for others. How does that stop them? There is always an element of rebellion but not all are rebellious. The question is what is/what is not legitimate rebellion behaviour?

- Best prevention impact is the cessation of smoking by adults; this has the most positive influence on young people.

- Gerova: What is best way to motivate general practictioners (in Slovakia) to introduce cessation strategy? Slama replies: motivate by brief training programmes, provide information for brief advice by the docters and introduce it to small groups first.

- Gerova: Although number of smoking adults decrease, more youngsters are known to start smoking in Slovakia. This problem lies in the society.

- Ursel: Related aspect: how do you come to define/understand best evidence/best practice? Evidence comes from data looking at evaluations, you find practices with enough evidence in a variety of studies. Determine what policies are available.

- Laubli Loud: Some countries have world pressure to take initiatives/measures. Important conclusion is that where measures were taken, they worked.

- Bouwens: What is the role of health promotion practitioners? In the Netherlands they feel uncomfortable with smoking as a topic and the role of a change agent. What can they do to change the environment? Dr. Slama replies that information that should be exchanged, is not exchanged.

- Stephan: It may link up with strand II: questions is how to do it? - This project is focussed on getting evidence: how do we use this framework? What

can practitioners do with this context? These protocols can be used at a later stage. - Mittelmark calls this case a demonstration of getting evidence into practice into

results. This illustrates a serious effort; - Saan admires this as a wonderful example of the synthesis, bringing together all data

from experiences that shows: o smoking area research over the past 30 years o it can be done on a large scale o there is a lot of information to build upon o It is a simple topic that has a clear impact o Capacity is not mentioned, but a lot is invested in it.

- Jones wonders if the word European should be put into the article?


From evidence to practice: case studies in mental health promotion (Strand III) The presentation was cancelled (due to illness of dr. Eva Jané-Llopis, Radboud University). Feedback on the article presented by Catherine Jones followed by discussion: Dr. Aro: is there evidence on health promotion education ? The four items should not be a straight jacket, mental health is at a different stage than tobacco. Dr. Jané has made general observations, that part could be removed to gain more space for what we know and what are challenges in mental health research. It is adviced to give more attention to those areas. Catherine will contact dr. Eva Jané-Llopis over these questions/comments.

Presentation Getting evidence into practice in health promotion (Strand III ) by dr. Viv Speller, Health Development consultant, also on behalf of co-author Erica Wimbush Dr. Speller presents an overview of some of the theoretical issues underpinning the drive to get evidence of effective health promotion into policy and practice illustrated by case studies of the exploratory work over recent years of two national agencies with this responsibility in the UK; the Health Development Agency (HDA) in England, and Health Scotland (formerly Health Education Board for Scotland and Public Health Institute for Scotland). The developed protocols favoured research over practice of health promotion prevention. The question in this study was how to include other research. The field has recognized limitation of research/evidence based medicine (EBM). There is a shift in focus from evidence health promotion outcomes to health promotion evidence. The proposal was to consider all four stages of the evidence-based policy and practice (EBPP) process:

- research review and collation of evidence - developing a disseminating evidence-based guidance - capacity building to deliver effective practice - learning from effective practice

Dr. Speller talks about the origins that lay in EBM, the dominance of the RCT, the theory of diffusion of innovations, the key principles for changing individual practice, the attempts to involve practitioners and policy-makers in both primary research processes and demonstrates with two case studies how two agencies with similar remits in different UK countries have attempted to draw on this emergent understanding and trial different approaches. She also refers to a capacity building framework developed in New South Wales, Australia. She feels that the use of the circle – as demonstrated by Hans Saan – is not enough. The issues she raises are that

- tensions in operating strands of activity based on different paradigms should be recognised

- there are now examples of explicit and tacit knowledge to draw on Questions for discussion:

- terminology may be confusing, they need clarification before the second GEP phase - are the descriptions of strands of activity clear and understandable? - Does the concept of knowledge ‘push’ and ‘pull’ help convey the different approaches

– or jargonize it? - Should the capacity building elements of activity be emphasized further?

Discussion that follows the presentation:

- Presentation links up with the strands - the concept of knowledge ‘push’ and ‘pull’ is very useful, comparable with supply and

demands (as in economics) - there is a logic in the circle>> push model that says collect and disseminate evidence

>> pull model: what kind might be relevant - there are two forces: push – pull and the type of information that is supplied does not

fit in the demand


- capacity and context elements in all three strands - the concepts in the publication are not easy, there should be more guidance for

readers - the review is professional oriented, give more insight in research conditions. - the article needs a sense of scale, there are different answers to the same questions - it is good to include cases; add concrete stories and clear guidelines

Dr Speller says thanks for the comments and will include them before Stockholm.

Presentation: Mapping European Capacity to Engage in Health Promotion: Policy, infrastructure and practice (Strand III ) by Maurice B. Mittelmark, Research Centre for Health Promotion, University of Bergen, Norway on behalf of Spencer Hagard Dr. Mittelmark starts by saying he is not in favour of circles, but will try to introduce consistency in presenting work in Strand III. The framework to which his paper is intended to contribute has four elements, which together provide a systematic approach to getting evidence about health promotion effectiveness into practice:

- Collate, review and summarise evidence of health promotion effectiveness - Disseminate the evidence in appropriate ways, to policy-makers and to practitioners - Assess capacity to implement evidence-based policy, programmes and practices - Learn from effective practice to support further capacity-building and improve

evidence base There are structural barriers that stand in the way of mounting effective health promotion. No information system spanning all of Europe is yet available that effectively and accurately pools experience and knowledge about what approaches to health improvement work best in various parts of the continent. Critical infrastructure needed to support health promotion practice is not yet widely in place, and barely in existence in many places. However, some examples of excellence can be found, but fragmentation and the cultural, economic and political complexities of Europe make it difficult to illuminate the exemplars, learn from them, and link up the pieces into a strong system of supports for health promotion practice. There is need for systematically collected information, on the country level to start, about the state of health promotion infrastructure, policies and programmes. The information should be easily accessible by policy makers, advocates for health. In the need for capacity mapping there are three objectives:

- we do not know enough - compare across countries and use it in an encouraging way - mutual learning on how to increase capacity.

There are different levels of capacity mapping approaches and limits to the quality of data. No single capacity mapping exercise can be comprehensive. Mittelmark shows the Venn diagram illustrating the context of health promotion infrastructure and talks about capacity mapping at national level, specifically referring to the Rutten et al. publication. An example of collaborative efforts that yield comparable data sets from different countries is the large series of country studies done by the European Observatory on Health Care Systems, which examines country capacity in five arenas. A capacity mapping model that does yield data suitable for international comparisons was developed by the WHO Regional Office for Europe, and used as part of its Investment for Health initiative. The HP-Source.net project was stimulated by experience gained in WHO country audits. Starting from a network funded originally by the European Commission, HP-Source.net has evolved into a voluntary, international collaboration of researchers, practitioners and policy makers, having the common goal to maximise the efficiency and effectiveness of health promotion policy, infrastructures and practices by:


• Developing a uniform system for collecting information on health promotion policies, infrastructures and practices;

• Creating databases and an access strategy so that information can be accessed at inter-country, country and intra-country levels, by policy makers, international public health organisations and researchers;

• Analysing the databases to support the generation of models for optimum effectiveness and efficiency of health promotion policy, infrastructure and practice;

• Actively imparting this information and knowledge, and actively advocating the adoption of models of proven effectiveness and efficiency, by means of publications, seminars, conferences and briefings, among other means.

Data collection takes place in two modules: Core module 1 (Dec 2002-Sept 2003 with data on the website); Core Module 2 had design and pilot testing done in 2004, further data collection first half 2005 (with 19 countries in the first phase to 35 by end of 2005) and will be launched in week 6 (11 February 2005). Speciality of the modules are Mental Health and Alcohol policy. Presentation will take place at the Stockholm conference June 2005 followed by Bangkok Health Promotion Conference with a technical paper, a session on capacity mapping and WHO Euro report on capacity (three parts: one HP-source.net). This database is a portal into other databanks, and provides an inventory. The sources are reports, they do not validate the quality of the reports. Health Promotion Bergen do validity checks. HP-Source tells who is doing what but says nothing about quality evidence/quality development. Feedback is necessary to review processes from HP-source. Translation at national level is another way. There not one good case study yet in respect to effectiveness of health promotion structures. Hans Saan mentions to the NIGZ as good case study, they have have a lot of experience and are currently building an ongoing inventory of capacity and will update this from time to time. Hans will provide Maurice with the necessary information. Mittelmark sees many benefits in IUHPE’s joining in the second phase of the GEP project. He writes a similar paper: stream on capacity map. Joining the second phase will provide opportunity to input HP.Source and EP Source and what GEP does in strand I and II. GEP should be in the picture , there are many possibilities. The EP-course is expanded with core module 2, Mittelmark hopes to do it with the GEP project. Anyone interested can mail him on [email protected]. Information on the IUHPE European Core Module, version 2 is available at the internet: www.hp-source.net and in PDF file on the GEP website.

Strand III Publications Catherine Jones, IUHPE, presents the publication schedule for IUHPE’s Promotion & Education’s special issue on Getting Evidence into Practice resulting in dissemination in June to the entire IUHPE global membership and subscribers to the P & E Journal, the entire GPHPE partners and regional projects, to all GEP partners and project team members. The proposed contents for this special issue on the Getting Evidence into Practice Project* is as follows: 1. Editorial : Capacity building as a condition for the use of evidence – Hans Saan (1400 words)

This paper would pick up on the contrasts of the various cycles of knowledge development and capacity building that are presented or cited in the issue.

2. How did we get here and what do we need? Jan Bouwens (700 words) A critical piece with reflection on the questions that brought on this European movement.

3. The European Region’s contribution to the GPHPE – David McQueen and Catherine Jones (700 words)

Opmerking [GST1]: Spencer to complete description of EC Phase, Maurice to complete post-EC phase


Collaboration with the GPHPE to incorporate the European Region’s approach as a contribution to the global debate and advancement in the field.

4. Joint article from Strands 1 & 2 – (5000 words) 5. The state of the art and evidence update - From evidence to practice: mental health promotion effectiveness – Eva Jané-Llopis

- From evidence to practice : tobacco control effectiveness – Karen Slama - Getting evidence into practice in health promotion – Viv Speller and Erica Wimbush - Mapping European capacity to engage in health promotion: policy, infrastructure and practice – Maurice Mittelmark et al.

6. Where are we headed? The next frontier – Catherine Jones et al. (700-1400 words) This will be a joint piece with all of the authors from section 5 whereby we may bring out some of the unresolved issues in the chapters and touch upon the commonalities and things around terminology. This piece could also be seen as a bridge to the second GEP phase.

1 - 3. Will be translated in its entirety into French, German and Spanish 4 - 5. Summaries of 500 words will be translated into French, German and Spanish *a complete list of the projects’ partners and participants will be put into an acknowledgements page.

Stockholm conference (preparations) 6th IUHPE conference on Effectiveness of health Promotion, entitled ‘Best practice for better health, Stockholm, Sweden 1-4 June 2005. Contributions from the project to the programme The Organizing and Scientific Committee of the conference has met in Stockholm, 10-12 January 2005 to discuss the programme, which has been printed out for participants in this meeting. The provisional programme is published (and will be updated) on the website: www.bestpractice 2005.se; there will be no second announcement mailing. Deadline for early registration (IUHPE reduction fee) is 23 March 2005. The GEP project is well represented and has a high profile in the form of keynote speakers, presentations and workshops. Instruments and insights into the building of evidence are presented from the three strands and from the project as a unity. Jan Bouwens presents the list of abstracts submitted by project members .At this stage there is clarity about acceptance for most contributions: Strand I:

• Workshop: A consensus based review protocol for HP • Workshop: Practicing the use of the consensus-based review protocol • Oral Presentation: Getting Evidence into Practice-Existing review protocols in HP/PH • Oral presentation: Getting Evidence into Practice- A conceptual map on collecting and defining/analysing

evidence for HP Strand II:

• Workshop: The development of a consensus based quality assurance instrument • Workshop: The quality guidelines experience: working with an European consensus based quality

assurance instrument • Getting evidence into practice: raising competence and capacity

Strand III: Under the GEP flag: link to workshop strand III: raising competence and capacity

• Workshop: Infrastructures available or needed for health promotion in different European regions • Workshop: The needed support to build capacity building in Europe for mental health promotion

Further presentations at Stockholm conference: • Workshop on Special Issue on Mental Health Promotion • A workshop on the Global Programme on Health Promotion Effectiveness • Workshop on National Strategies Development (case studies) • Workshop on the challenge of getting evidence into practice (within changing environment)

General: Hans Saan/Willy de Haes: workshop: Knowledge Management of health promotion Pre-conference projectmeeting Clarification by Jan Bouwens


The GEP organisation intends to hold a pre-conference for the project participants in Stockholm on May 31st, one day before the start of the Effectiveness conference. It is meant to be a team meeting, doing strand business, finalizing the deliverables, working on long term strategy, discussing evaluation/implementation and accession of other countries. The GEP organisation is looking for means in the budget to facilitate members, partners and affiliated/interested parties to participate. The budget does not allow compensation for all, but there needs to be a fair balance in reimbursement to facilitate for instance accession countries/less privileged countries. In order to do so, a registration form will be sent out by the GEP-secretariat to all project members with the following questions:

- do you intend to participate in the GEP pre-conference meeting on Tuesday 31st May 2005?

- If so, can you/your organisation pay for the extra expenses (i.e. extra night at the hotel?)

- If you cannot pay the extra costs, what costs would you prefer to have reimbursed? - A formal permission from the European Commission will be required for these (extra)

reimbursements.

Second Phase application project Getting Evidence into Practice During the Steering Group meeting (2nd February) it is decided to submit a proposal to the DG Sanco (and not to the ERA Net as well) for funding from the European Commission Programme on Community Action in the field of Public Health 2005. Deadline submissions: 15th April 2005. A sheet is presented showing the outline for a balanced proposal for funding a second phase of this project, running for 2,5 years (August 2005-January 2008), working with a central co-ordination (from the NIGZ) and two strands (reviews and guidelines). Jan Bouwens and Gerard Molleman explain the original elements

- capacity assessment and capacity building/implemenation - use of instruments (developed in phase I) in own country - a number of meetings on certain topics in order to decide what needs to be done

eg. results of assessment tool), as well as working meetings and intervision meetings. - Looking for a common working plan which can easily be applied in other countries. - This Second Phase of GEP to be concluded during the EUPHA conference in

Helsinki, October 2007. The first proposal (April 2004) although judged favourably by the DG Sanco on the working plan and added community value, was rejected on aspects such as high costs. Results of the plenary discussion that follows:

- Speller: do not keep strict separation, but use the process of integrated…. - Costongs: do not use same two processes, tools differ, do not have twice

assessment of capacity for review protocol and quality assessment tool. - Mittelmark wonders what the role of IUHPE in this proposal is? IUHPE wants to

rethink on the whole application. Where is the partnership in this umbrella? - Hans Saan: strand I review is not simple, you cannot support all health promotion

activities; Take all reviews on a certain topic, i.e. smoking and see/learn from it and share reviewing process. Strand II instrument is diversity on local level. These two have different natures, but should still be connected.


- Ursel Broesskamp: materialize the goal to establish Evidence Consortium for long term existence and use explicitly the input of first phase to further develop with link to global programme of Effectiveness.

- Costongs: promote to translate the tool for further dissemination. - The goal is to disseminate the instrument further.

Jan Bouwens concludes by saying that valuable suggestions and some valid criticism is heard in comments as:

- leave the idea of separate strands - work from the evidence cycle and more from a sustainability perspective - work out more specific the idea of an evidence consortium - include members and partners more explicitely - use the existing capacity instruments and infrastructure, do not leave out the

marketing and promotion aspects

Jan Bouwens will see how these ideas can be integrated in the proposal and the draft text will be discussed with the members of the Steering Group before submitting the application.

Epilogue In concluding the meeting Jan Bouwens sums up the work done and to be done: He is impressed by the work project wise and content wise by the strand holders who have done a great and sometimes stressful job. They heavily depended of course on the input and quality input was delivered during this meeting. Participants proved in this phase of the project where the instruments are getting form. Questions on applicability in different use by several stakeholders are vital. In September Jan Bouwens was already enthusiastic about the capital and expertise and the high sense of involvement from the participants in the project. The positive thing is that there is a growing synergy and a sense of synthesis. He feels that a sense of partnership certainly is a necessary ingredient for the near future. Quit a lot has been achieved in the inventory phase and the ongoing analysis work of strand I and II and strand III offered and stressed important building stones for the wholeness of the project . For the consensus phase, the Delphi rounds and for the pilot testing of the instruments of strand 1 and 2, active involvement of the members is again needed. When deciding to join the project as a member or partner, organizations agreed to a certain amount of own investment. After the meeting in September a clarification was sent to the members on this own investment: quantified in 60 days. This could mean things like attending to and preparing these meetings, delivering input for the instruments, disseminating insights within the own institutes. The coming months, and certainly in relation to the pilot testing, some work needs to be done outside this so-called own investment. In the budget there is room for extra tasks. When and what extra tasks are to be done will become clear in the course of this joint working process in the strands and will be arranged in communication with strand holders and parties involved. There is, given the relative short amount of time and the limited resources, a certain tension between keeping the project going on as a ‘simple’ production process and the project seen from the perspective of linking the different working processes, keeping everyone involved at their own pace and keeping the long term strategy in mind. The GEP co-ordination has an eye for this.


In the meantime there is work to be done. Jan is happy that EurohealthNet and IUHPE are involved, a feasible expansion plan for this phase of the project has to be worked out: who are covered the land map cover and who has to get involved in one way or another. The evaluation questionnaire will be emailed to all participants soon after the meeting.

Closure In reporting back on Day I Hans Saan shows a slide of a wheel , talking about hidden knowledge that should be made explicit, exchanged and improved. For the workshops he warns to look in the discussions for consensus on criteria and tools, and to be clear what can be covered in introductory texts and what in the handbook for use. On day II Hans Saan concludes the strandmeeting with a song on the following text: (¯melody :Alle Menschen werden Brüder¯)

• To get Evidence into practice • It needs to be practical • So include capacity, context • And how to empower Health for all.

• Here we worked on a shared learning • Making us an Euro-brain • As we are not used to do that • Its the dialogue we will maintain

• From ideas and fuzzy images • Came our texts and tools and more • With great passion we debated • To separate nonsense from the core

• To get anything into practice • You have to be practical • Make it look concise and simple • Promise the best to solve it all

• Lucky us we are supported • By clever people, bright and quick • Who enjoy our comments clearly • You see they keep their smiles still big.

• Now on our way to Stockholm • Lots of emails in between • there for all our €(euro) colleagues • We’ll stage the greatest show ever seen

End of minutes Strandmeeting 3-4 February 2005


List of Participants Project ‘Getting evidence into practice’ Strandmeeting 3-4 February 2005

In alphabetical order of country



Belgium Subcontractholder Strand 2

Mr. Stephan van den Broucke [email protected] Mrs. Caroline Bollars [email protected]

Flemish Institute for Health Promotion Schildknechtstraat 9 B-1020 Brussels

Tel: +32 2 422 49 49 Fax: +32 2 422 49 59 Tel: +32 2 422 49 38

Belgium EuroHealthNet Communications

Mrs. Caroline Costongs [email protected]

EuroHealthNet Rue Philippe Le Bon 6 B-1000 Brussels

Tel: +32 2 2350 320 Fax: +32 2 23 50 339

Czech Republic Mrs. Hana Drahonovska [email protected]

National Institute of Public Health Srobarova 48 100 42 Prague 10

Tel: +420 2 67082548 Fax: +420 2 6731 02 91

Denmark (absent partner)

Finn Kamper-Jorgenson, director [email protected]

Danish National Institute of Public Health Oster Farimagsgade 5 DK-1399 Copenhagen-K

Tel: +45 39 20 77 77 Fax: +45 39 20 80 10

Denmark Mrs. Birgitte Gade Koefoed [email protected]

National Board of Health Islands Brygge 67; DK-2300 Copenhagen S

Tel: +45 72 22 74 45 Fax: +45 72 22 74 13

Denmark Dr. Christiane Stock [email protected]

Department of Health Promotion Research, Institute of Public Health (DHRP) Niels Bohrs Vej 9 DK-6700 Esbjerg

Tel: +45 6550 4210 Fax: +45 6550 4283

Estonia (absent partner)

Dr. Anu Kasmel, director [email protected]

Estonian Union for Health Promotion Mustamae tee 4 10621 Tallinn

Tel: +372 51 05 621 Fax: +372 62 79 281

Finland Subcontractholder Strand 1

Mrs Arja Aro senior advisor [email protected] Mrs. Sanna Räty, project coordinator [email protected]

National Public Health Institute KTL Dept.of Epidemiology and Health Promotion Mannerheimintie 166 FIN-00300 Helsinki


Finland (absent partner)

Mr. Mika Pyykko [email protected]

Finnish Center for Health Promotion Karjalankatu 2 C 63 FIN-00520 Helsinki

Tel: +358 9 7253 0300 Fax: + 358 9 7253 0319

France Mrs. Stephanie Pin (Strand I) [email protected]

Institut National de Prévention et d�Education pour la Santé 42 Blvd. de la Libération 93203 St. Denis Cedex

Tel: + 33 1 49 33 22 22 Fax: + 33 1 49 33 23 90

France IUHPE Subcontractholder Strand 3

Mrs. Catherine Jones [email protected]

IUHPE 42 Blvd. de la Libération 93203 St. Denis Cedex

Tel: + 33 148 13 71 20 Fax: + 33 148 09 17 67

Germany

Mr. Volker Stander [email protected]

Bundeszentrale für Gesundheitliche Aufklärung Referat 2-25, Wissenschaftliche Untersuchun-gen, Qualitätssicherung Ostmerheimerstrasse 220 51109 Cologne

Tel: +49 221 89 92 330 Fax: +49 221 89 92 300

Greece

Mrs Christina Dimitrakaki [email protected] (replacement for prof.dr.Y. Tountas)

Institute of Social & Preventive Medicine ISPM 25 Alexandroupoleos Street 115 27 Athens

Tel: +30 210 748 20 15 Fax: +30 210 748 58 72




Italy (absent partner)

Mr. Giancarlo Pocetta [email protected]

Experimental Centre for Health Education Universita Degli Studi Di Perugia Via Del Giochetto CP n 1435 06126 Perugia

Tel: +39 75 585 73 01 Fax: +39 75 585 7317

Latvia Mrs. Ineta Zirina [email protected]

Latvian Health Promotion Centre 3 Skolas street Riga LV-1010

Tel: +371 72 4 04 47 Fax: + 371 72 4 04 22

Netherlands NIGZ Coordinating organisation

Mr. Gerard Molleman, project manager [email protected] Mr. Jan Bouwens, project coordinator [email protected] Mr. Hans Saan, senior advisor [email protected] Mrs. Vivian Bos (strand I) [email protected] Mrs. Henriette Kok (Strand II) [email protected] Mrs . Marianne Smit, project assistant [email protected]

Netherlands Institute for Health Promotion and Disease NIGZ Prevention P.O. Box 500 3440 AM Woerden

Tel: +31 348 437 600 Fax: +31 348 437 621 GEP Secretariat. M. Smit Tel: +31 348 438 853 Fax: +31 348 437 666

Portugal (absent partner)

Mr. Pedro Ribeiro da Silva [email protected]

General Directorate of Health Alamada D. Alonso Henriques 45 1049-005 Lisboa

Tel: + 351 218430500 Fax: + 351 218430530

Slovakia Mrs. Zora Gerova [email protected]

Public Health Institute of Slovak Republic 826 45 Bratislava Trnavská 52

Tel: +4212 52961121 fax: +4212 52961124

Slovakia (absent partner)

Mrs. Maria Avdicova, [email protected]

Regional Authority of Public Health, Banska Bystrica Cesta k nemocnici 1 Banská Bystrica 975 56

Tel: +421 484153261 Fax: +421 484123637

Spain (absent partner)

Mrs. Begona Merino Merino [email protected]

Ministry of Health Paseo del Prado 18-20, 28071 Madrid

Tel: + 34 91 5964194 Fax: + 34 91 5964195

Sweden

Mrs. Mia Danielsson [email protected] (replacement for Mrs. Carina Kallestal)

Swedish Institute for Public Health (SNIPH) International Relations Olof Palmes Gata 17 S-10352 Stockholm

Tel: +46 8 5661 35 15 +46 8 5661 35 00 Fax: +46 8 5661 35 05

Switzerland Marlène Läubli Loud Head of Evaluation Resource and Management Centre [email protected]

Swiss Federal Office of Public Health Schwartztorstrasse 96 CH- 3003 Bern

Tel: +41 31 323 59 76 Fax: +41 31 323 8805

Switzerland Mrs. Ursel Broesskamp-Stone, [email protected] Mr. Günter Ackermann Head Quality and Evalution [email protected]

Health Promotion Switzerland Dufourstrasse 30 Postfach 311 CH 3000 Bern 6

Tel: +41 31 350 04 25 04 Fax: +41 31 368 17 00 Tel: +41 31 350 04 31

United Kingdom Brighton IHDRC (absent partner)

Mrs. Caroline Hall, MA BSc [email protected] dr. John K. Davies Regional vice-president IUHPE/EURO [email protected]

International Health Development Research Centre c/o Faculty of Health, University of Brighton, Falmer, Brighton BN1 9PH United Kingdom

Tel: +44 1273 644168 Fax: +44 1273 643324 Tel: +44 1273 644169 Fax: +44 1273 644508




United Kingdom Health Development Agency HDA, UK

Catherine Swann [email protected] replacement for Mr. Jeff French, director Antony Morgan [email protected] Mr. Chris Brookes Chris [email protected]

Head of Underlying determinants of health Health Development Agency Holborn Gate 330 High Holborn London WC IV 7BA

Tel: +44 2070613170 Fax: +44 207 061 3390 Tel: +442074300850 Tel: +442074300850


Mrs. Erica Wimbush [email protected]

Health Scotland Woodburn House Canaan Lane Edinburgh EH10 4SG

Tel: +44 131 536 55 88 Fax: +44 131 536 55 02

United Kingdom Wales

Dr. Nina Parry-Langdon [email protected]

Research and Evaluation Branch Welsh Assembly Government Cathays Park Cardiff CF10 3NQ

Tel: +44 29 208 26 522 Fax: +44 29 2082 5779

STRAND III Authors International Union against Tuberculosis and Lung Disease

Dr. Karen Slama ([email protected])

68, Boulevard St. Michel, 75006 Paris, France

Tel: +33156802826 Fax +33156802820

IUHPE president

Dr. Maurice Mittelmark [email protected]

Research Centre for Health Promotion University of Bergen Christiesgt 13 N-5007 Bergen

Tel: +4755583251 Fax: +4755589887

Prevention Research Centre Academic Centre for Social Sciences Radboud University of Nijmegen (absent)

Dr. Eva Jané- Llopis [email protected]

Head of Science-Based Knowledge and Policy Prevention Research Centre Academic Centre for Social Sciences, Department of Clinical Psychology Radboud University Nijmegen P.O. Box 9104 6500HE Nijmegen The Netherlands

Tel: + 31 24 361 26 67 Fax: + 31 24 361 55 94

Author/consultant Dr. Viv Speller [email protected]

Health Development Peacehaven, Uplands Road Denmead, Waterlooville Hampshire, PO7 6HE United Kingdom

Tel: + 44 2392 232 741

EVALUATION AMC Amsterdam (Evaluation of the project)

Mrs. Marina Grichchenko [email protected] on behalf of Prof.dr.N.S. Klazinga [email protected]

Academic Medical Centre Dept. of Social Medicine P.O. Box 22660 NL-1100 DD Amsterdam The Netherlands

Tel: +31 20 566 4892 Fax: +31 20 697 2316


Strand meeting Project Getting Evidence into Practice (GEP) EC project no. 2003123 (790841) Evidence Consortium. Date: Tuesday 31 May, 2005: 13.00-18.00 pm and Wednesday June 1: 9.00-12.00 am. Venue: room 456 Norra Latin Conference building, Stockholm Pre-conference meeting on the eve of the 6th IUHPE conference on Effectiveness of health Promotion, entitled ‘Best practice for better health Participants: see list of attendants (45 present) MINUTES of the meeting Opening and welcome After meeting and greeting the attendants (members, partners and interested parties) and a short round of introduction, Jan Bouwens (project leader and chair) opens the meeting with a word of welcome, presenting the programme elements for Day I:

- short introduction of participants - brief ‘looking back’ on GEP phase one - presentation and discussion on work process, tools and deliverables of the three strands - subgroup meetings strand I and II after their presentations - optional informal gathering for newcomers and interested (in second phase) partners - plenary feedback and conclusions of the subgroups - evening dinner at 19.00 pm

STRAND I Presentation by Sanna Räty (KTL Finland) on the review protocol. Strand I has been working on the development of the consensus-based European review protocol for Health Promotion (HP) and Public Health (PH). Background is that Health Promotion reviews so far are mostly based on EMB protocols. Furthermore, there is a need to broaden the evidence base, a need for a review protocol for HP/PH and the need for coherent and unified way of looking for evidence in health promotion inside the Europe. Aim of strand I is to support the main aims of the GEP by producing a consensus-based review protocol on how to select literature and expertise as they appear in research, policy and documents as well as in HP/PH practice. Within the time frame April 2004 - July 2005, the main steps consisted of 1. creating a conceptual map; 2. making an inventory on existing review protocols/quality criteria for reviewing literature by way of a survey by the GEP, Strand I participants and literature search; 3. reaching a consensus on the European review protocol by way of a Delphi exercise in a working meeting, two Delphi rounds and holding a consensus meeting here in Stockholm. 4. Pilot testing (feasibility test is on going). All four steps are explained in detail (see powerpoint presentation). The challenges they faced were how to asses the quality criteria: à Own quality criteria for reviewing evidence for HP information (which should not be mistaken for a tool) à Recommending some of the existing ones . Furthermore, the grading of the evidence is an important topic. The added value of a European review protocol for health promotion is that the review protocol is aimed at for HP/PH actors (moderate experience on research/reviews); will have HP/PH perspective; shows a broader view of evidence: acknowledges also the practical know-how and finally, enables the collaboration between different countries. Mrs. Räty concludes by presenting the challenges for the future: - highlighting some of the provided examples (e.g. quality criteria) as the most reliable; - concentrating on the development of the evidence grading for non-research information; - including practical examples of the reviewing process by applying the protocol in practice in a certain topic (as input for a validation phase of the protocol); - developing training material and guidelines on how to use the European review protocol. Sanna Räty receives positive feedback from the audience on process and outcome. Attendants are looking forward to the final results. STRAND II Presentation by Henriëtte Kok (NIGZ) and Caroline Bollars (VIG) on the Quality Assessment (QA) tool. QA-tools in health promotion are a recent development in striving towards evidence-based health promotion. A limited number of countries have developed QA-tools. Within the European Union there is –until now- no consensus in the definition, conceptualisation and operationalization of quality


assurance. As a results, different forms of instruments are currently in use, showing a great deal of overlap, yet also some variation in terms of content and format. To obtain more uniformity and facilitate cross-national comparisons and collaboration in improving quality, the aim of strand II has been to develop a consensus-based European Quality Assessment tool for health promotion. The work was divided into three steps: first an inventory was made of existing assessment tools in and outside Europe. Secondly, the participation of project members was requested by means of two Delphi rounds and a consensus meeting (which took place in Woerden, February 2004). The third step was pilot testing the agreed tool on a number of projects, after which adjustments were made. In the presentation the three steps are explained in detail (see powerpoint presentation). It is proposed that the European consensus tool, which facilitates the assessment and improvement of quality of health promotion projects, is called the European Quality Instrument for Health Promotion (EQUIHP). It is a combination of a checklist to assess the quality of health promotion projects, and a set of guidelines to improve their quality. EQUIHP consists of the following components: • a Scoring Form, which contains 13 criteria for effective health promotion interventions, as well as a

number of indicators for each criterion; • a User Manual, which provides explanations and instructions for the use of EQUIHP. The criteria in the scoring form are clustered into four types, reflecting the factors which are important for effective health promotion: the framework of health promotion principles, aspects of project development and implementation, aspects of project management, and sustainability. Referring to these criteria, EQUIHP can be used as a checklist for writing a project proposal and improving the quality of an intervention, but can also be used for the assessment of projects. The User Manual provides a description of the EQUIHP-tool, outlining the theoretical background and the model on which it is based, as well as the various possibilities for its use and the types of health promotion projects to which it can be applied. In addition, it offers instructions on how to use EQUIHP, outlining the focal points for quality assessment and quality improvement, respectively, and explaining the ways to interpret the results. Discussion: There is a lot of appreciation from the audience for the work, carried out by strand II. The question is asked whether the tool can be applied to several projects? Research projects are too difficult to assess, it has still to be defined which indicators are most usable. A special stakeholders meeting is planned for July 2005, in Leuven (Belgium). Aim of this meeting is to discuss how the EQUIHP tool can be implemented over time, both in countries that already have a quality assurance tool and those that do not have quality assurance criteria or tools in use. Another question is about why criteria are excluded? Are valuable insights not skipped? The project coordinators stress that the tool was developed based on consensus of the participating countries. The tool could be used in other health areas as well, or in cross over projects. Indicators are not weighed in marks. A procedure for rating indicators will be developed in the (possible) second phase. STRAND III Presentation by Catherine Jones, project manager IUHPE The deliverable of strand III consists of a special issue of the IUHPE’s journal Promotion & Education (P & E). This special edition, printed in four languages is called: The challenge of getting evidence into practice: current debates and future strategies. It contains acknowledgements and presentation of project strands, team members and partners, an editorial and 8 articles (5 scientific articles, 3 being more reflection pieces or commentaries) on the following items: Current agenda; Technical issues; Reviews of evidence; Capacity building; Future action. In developing the contents, they were working with the four main authors (Eva Jané-Llopis, Maurice Mittelmark, Karen Slama and, Viv Speller), the GEP steering group members, the leaders of Strands I and II, other global partners and interested stakeholders, the guest Editor Hans Saan and Communications specialist Angela Scriven. The process consisted of identification of critical issues and outlines using IUHPE’s blueprint methodology; engaging other contributing authors and partners in articles to convey the broad European spectrum; bringing attention to the historical aspects, current situations and future


perspectives; highlighting the European value-added, whilst drawing upon the experiences and knowledge from other parts of the world. Dissemination In the European region, the publication will be launched at the upcoming 6th IUHPE European Conference on the Quality and Effectiveness of Health Promotion (June 1-4, 2005, Stockholm). All GEP project steering group members, participants, team members and partners received a copy. Moreover, there will be a special campaign in England with 500 copies earmarked for National Institute for Health and Clinical Excellence as well as in Spain with 500 copies earmarked for the Spanish Ministry and electronic copy on their national health promotion website (www.sipes.es). Globally, over 2500 copies are sent out to all IUHPE members and P & E Journal subscribers. It will be sent to all partners and members of the Global Programme on Health Promotion Effectiveness and a PDF version will be highlighted on the homepage and available on the IUHPE’s website (www.iuhpe.org) in publications section. Future As far as the future is concerned, there are five key issues which dominate the publication and position current situation:

• Nature of evidence; • Need for a common framework for getting evidence into practice; • Workforce capacity and capability; • Linkage between research, policy and practice; • Collaborative action and need for unified terminology.

The recommendations are: F Strengthening networks within and between countries to share learning; F Fostering mixed communities of research, policy and practice; F Establishing new professional roles; F Collaboration to continue assessing current capacity; F Establishing training initiatives for increasing capacity.

Discussion: The special edition is handed out to all attendants and is well received. There are many compliments on the production and the P & E supplement is characterized by the audience as a source of inspiration. SUBGROUP DISCUSSIONS After a break, the audience is divided into two discussion subgroups which report back plenary. For a small party (representatives from Slovakia and Wales), there was a clarifying discussion with the project leader. Results subgroup strand I Review protocol A heated and yet good humoured discussion took place on the issue of research evidence and non-research evidence. They are not different and all valuable. Systems exist to use research, but few are ready made. With the emphasis on how to improve health promotion interventions all areas, policy documents, etc are needed. There is a multiple dimension on every review issue you look at. This review protocol is a description of knowledge of this moment, still need to look further. Consensus was not reached on all elements but differences in views/values can be made more explicit and substantiated. Final conclusion: there is more work to be done. Results subgroup strand II Quality assessment tool Consensus was reached on the name of the tool: European Quality Instrument for Health Promotion (EQUIHP). It was advised

- to expand the manual with an example of each indicator how to score - to add information on items of several stages - show possibilities on how to use the tool - for the second phase: make people want to use the tool and compare in different countries - to make internet versions.


Closure Day I Chairperson Jan Bouwens concludes this first working day in summarizing the results of the working groups and stating that it was a fruitful day. On leaving the room, all attendants receive a Thank you note with a picture of the project organisation people as well as a (typical Dutch) bookmark as a small token of appreciation for the collaboration and participation in the project Getting Evidence into Practice. Evening dinner takes place at 19.00 pm, which takes place within the same conference venue. Wednesday 1 June 2005 9.00-12.00 am Room: NL 456 Music Room Norra Latin Jan Bouwens (project leader and chair) re-opens the meeting, presenting the programme for Day II: - Presentation and discussion of the (interim) evaluation of the GEP project. Marina Grishchenko, Researcher, Department of Social Medicine, Academic Medical Centre (AMC), Amsterdam. - The proposal for the follow up project: implementation and sustainability. Caroline Costongs, Programme Manager EuroHealthNet and Jan Bouwens (NIGZ) - Questions and discussion on a possible long term GEP strategy. - Reflections by Hans Saan, senior advisor NIGZ/GEP steering group member. Presentation of the evaluation of the project (so far) Mrs. Marina Grishchenko from the AMC Dept of Soc.Medicine in Amsterdam presents an overview of the current results and the interim evaluation. She explains that the project is considered successful if it runs to budget and on time, if it presents its promised deliverables and products and if it established lasting collaboration. Her final report is expected in August 2005. The aim of the interim evaluation was to assess the project performance during the working process to facilitate the successful project completion. Objectives were to reveal and report on project’s intermediate achievements, as well as areas of potential concern; to collect feedback from the project participants and to generate recommendations. Focus was on the working process: communication, collaboration, management as well as quality and content of the intermediate project results, consensus-building. The interim evaluation has been carried out, using data, such as 2 questionnaire surveys, telephone interview survey and project documentation: minutes of strand meetings and steering group meetings, newsletters, website and draft documents. The method used is qualitative and quantitative data analysis. The feedback mechanisms used were interim reports and meetings with project leaders (NIGZ). Aim of the evaluation of the project results is to assess the project deliverables and conclude on the success of the project. These project deliverables consist of products of each strand and external communication and project visibility. The method and criteria used were quantitative estimation of the success in achieving project deliverables and qualitative evaluation of the developed instruments: criteria of scientific rigor, reached consensus, and acceptability by the project participants. Timing of the results is at the final stage of the project. Prior to this meeting (28 April-12 May) a telephone interview survey was held consisting of 28 interviews of approx. 30 min. The issues discussed were 1. General impressions on the project; 2. Working process (within strands and overall); 3. Views on achieved results, future potential and the lasting impact of the project. There was a high response rate (90%) and a positive attitude towards participation. The following results are based on the most widespread comments. The general impressions are: - Ideas and motives behind the project are relevant and important - Effective collaboration, opportunity to work together - Appreciation of the implemented work and prospective results - Project is well coordinated and managed - Valuable learning experience - A lot of future potential, worthwhile to be continued, willing to participate further.


The working process was evaluated on Organization and Communication, Meetings and Delphi rounds. Comments on Organization and Communication: - Overall good organization - Most information: from meetings and e-mails of strand holders - Newsletter widely read, highly appreciated - Website is a source of background information, but not used as a communication panel. Meetings are evaluated as: - Very well organized - Contributed to the effective working of the project - Provided valuable information on the project - Still: more discussions would be helpful - Suggestions made are to organize additional meetings, have more discussions at the meetings; make use of telephone conferences and have more discussions in-between the strand meetings. The Delphi rounds received an overall positive feedback and appreciation of the work done. The individual feedback was well reflected and positions converged towards consensus. Time requirements may have been underestimated. More clarity in the division of responsibilities between partners and project team members is needed. As far as terminology within the project is concerned Health Promotion terminology and used approaches differ a lot across countries. Different understandings depend on individual backgrounds of project participants. Key examples: definitions of “Evidence” and “Health promotion”. It was suggested to have terms more accurately defined from the very beginning and that a glossary may be helpful. The survey showed that at the initial stages getting into the project required more information on - strand aims, scope of work, expected results, target groups for deliverables - rationale behind those choices - roles and responsibilities of the participants. Suggestions for Phase 2 in that respect were to have more communication, discussion in the very beginning of the project. Emphasis should be on informing the participants who join later. Various items on dissemination and Implementation were commented on: - Feasibility test: it is suggested to clarify what they add to current practices and make them more user-friendly. - Make translation of deliverables a priority - For publications assistance is needed from coordinators in preparing/sharing materials for publications - National conferences would be helpful - On national websites, links to GEP website should be available - Strengthen the link to Public Health education On the topic of Learning and Cooperation, participation in the GEP project proved to be a substantial learning experience for many project members. Sharing knowledge between countries was deemed important. The GEP meetings were found to be a useful forum for discussions with colleague Health Promotion experts. There is a network building effect beyond the GEP project as new partnerships are formed and existing links are strengthened. When looking to the future, the majority of participants are positive about continuing the project and looking forward to a second phase of the project. Some have plans to disseminate and stimulate the use of the produced tools regardless the approval of the second stage. The presentation of the evaluation is concluded by naming the benefits and advantages of the project: - the project has delivered unified and consensus-based tools set at European level - project membership consisted of involvement of researchers, practitioners and policy-makers; enthusiastic and dedicated core teams; active involvement of other project members. - Good collaboration proved a key for the success. Some suggest to keep the network going beyond the completion of the first phase. - Project management was considered professionally organized and well managed.


DISCUSSIONS Gerard Molleman, project manager, adds that evaluation was part of the EU project agreement. It was good to have external evaluation to hear not only positive results, but also comments, suggestions, advice for improvement and/or changes. Looking to the future (and possible second phase) he states that the strandholders like to keep their roles, tools should be further developed and more information should come out. Catherine Jones state that people having isolated access to information are linking more to the working programme , showing parallels of strands. There is a lot of common grounds in the strands. The project should look at bringing the two tools together, articulate the links. Caroline Costongs thinks that at Steering Group level, communication goes on without participants knowing. She stresses that more time for discussions is needed. There should also be more time for working groups. Perhaps the number of emails should be reduced. Arja Aro feels that they have been working much at an abstract level, it could be more concrete in the next phase. We should learn from the first stage and set the goals and priorities more clearly. The plan was ambitious. We should be more realistic. She is doubtful about a glossary, members use terms, the strandholder checks. There are already many glossaries. Saan confirms that there are a number of glossaries in the field of evidence. He suggests to link to those and make a small one related to this project. Mrs. Dumitrescu adds that WHO does not have a glossary, working with an international group of experts, there is still no consensus on definitions. She deems it a futile effort to try. Final conclusion is that the glossary for the GEP project should be a list of definitions for clarification. The proposal for the follow up project: implementation and sustainability. Presented by Jan Bouwens (NIGZ)and Caroline Costongs, Programme Manager EuroHealthNet The proposal for a second phase of the project Getting Evidence into Practice was sent in April 2005 to the European Commission’s DG Sanco Programme on Community Action in the field of Public Health 2005, requesting co-financing of 976,524 Euro (total budget 1 641 984). There is a tough competition with more than 400 applications. The first phase of 18 months was a production – process period aimed at the development of instruments, building and expanding the Evidence Consortium, working with separate strands and mainly production oriented. The Phase Two proposal (duration 2 years, proposed start November 2005) carries the characteristics of implementation, application and use of tools, capacity building, synergy between practitioners and policymakers, and transferability. The objectives are: ü Implementing the consensus based protocol and QA-Tool ü Assessing and building the capacity in using the instruments ü Updating the evidence and best practices in the field of obesity prevention/health inequalities ü Strengthening the Consortium

Project structure and work process consist of: ü One coordinating party (NIGZ) and Steering Group (former strand holders) ü Five steering group meetings ü Four plenary meetings ü Capacity building/training meetings ü Fifteen extra work visits reserved ü Eight work packages linked to finalizing deliverables

Caroline Costongs continues by presenting eight integrated work packages (as part of phase 2): Work packages that lay a foundation for sustainability : ü Coordination ü Dissemination ü Evaluation ü Strengthening the Consortium

Work packages representing work cycle: ü Assessment of capacity and needs ü Application of tools ü Building the capacity ü Validating (and translation)of Instruments


Work packages (WP) presented by Caroline Costongs, EuroHealthNet WP 1 Coordination of the project (NIGZ) ü Provide the necessary infrastructure - facilitate capacity assessment, training and

implementation of the tools ü Organise and prepare 5 steering group meetings and 4 plenary meetings for all project

partners ü Communication (Website, newsletters) ü Responsible for various reports (including Interim and final reports to the EC) ü Budget holder

WP 2 Dissemination of project (IUHPE) ü Produce a communication and dissemination plan and ensure visibility ü Build on existing contacts, European and national networks via project partners ü Submit publications and articles (project partners are encouraged to become co-authors) ü Organise workshops and presentations at relevant conferences

WP 3 Evaluation of the project (NIGZ) The project is successful if it: ü runs within proposed budget and time ü presents the agreed deliverables ü disseminates the results widely ü establishes a long term collaboration ü has a happy consortium!

• General evaluation on outcome and process • External evaluator: Department of Social Medicine of the Academic Medical Centre of the University of Amsterdam WP 4 Strengthening the Consortium (EuroHealthNet) ü Advocate for the Consortium in the European arena – raise awareness for the work of the

Consortium to EU Institutions and relevant other European organizations. Build partnerships with HEN etc, and ensure input to the EU Platform on Diet and Physical Activity

ü Strengthen the consortium: encourage contacts within, and the expansion of the Consortium ü Explore the issue of transferability of evidence from one country to another (project partners

will be consulted) ü In dialogue with project partners, to contribute to a long-term strategy for the Consortium and

a sustainable implementation of the tools

WP 5 Assessment of capacity and needs (VIG Belgium) ü Design an instrument to assess the individual, organizational and contextual capacities of

HP/PH professionals to use the two tools ü Draft an assessment report (strengths and weaknesses) per country by project partners, as a

basis for capacity building ü Analysis and overview report (used for capacity building and for refining the tools)

WP 6 Production of a review on obesity, with a focus on health inequalities (KTL Finland) ü Apply the review protocol and the QAT tool on the issue of obesity prevention in relation to

health inequalities, in collaboration with project partners: - overall evidence with the review protocol

- evidence via best practices with the QAT (=EQUIPH) tool ü Integration of findings in one report on obesity prevention and in a scientific publication ü Presentation of results to different stakeholders and end-users of tools, also for feedback to

refine the two tools WP 7 Building the capacity (NIGZ with WP leaders) The aim is to enhance the capacity of HP/PH professionals and organizations to use and implement the review protocol and QAT (=EQUIPH) in their own context. ü Start the application of the two tools ü tailor made training sessions and country visits (based on the assessment reports) ü exchange and twinning aspects (clustering according to needs)


ü Pool of trained trainers ü Summary report

WP 8 Validating the review protocol and QAT (=EQUIPH) (KTL Finland) Input: à Feedback from the capacity assessment exercise à Feedback from the review process/application of tools à Lessons learned during the training/capacity building à Discussions at the meetings à Project evaluation

Leading to: ð Revision/validation of the two tools & their instructions ð Translation of the tools in all languages in collaboration with the project partners ð Ensuring accessibility of tools (publication and dissemination)

Contribution of the partners (24 organisations) ü Prepare and perform the assessment of capacity in your country ü Apply the tools / contribute to the review of the evidence and best practices in the field of

obesity prevention with a focus on health inequalities ü Participate in 4 plenary meetings and deliver agreed input ü Participate in training and capacity building activities linked to the implementation of the tools

in your own context (depending on needs) Questions & Discussion on the GEP Second Phase Question: what is consortium? It should be visible in Europe to be THE consortium on evidence into practice. How to formalize/be informal: it is up to the GEP to define what will be the strategy. G. Molleman stresses that translation into all languages should be a first step. Saan refers to review protocol: scientific aspects and practitioners’ experience. Why start the review on obesity if everyone is looking for the same source, going through the motions. Applying for review protocol to see how countrywise feeds into the evidence in the different countries. What is the purpose then? We should focus on how do we handle the tool, and we should not be too technical. Arja Aro confirms the research part will be done, coming to practice. Main emphasis is what is the added value of the protocol. Jan B: some countries will take part in training sessions, some will contribute more to the production process depending on capacities and needs. Long-term GEP Strategy The programme is continued with a brainstorm on the Potential Activities of the GEP Consortium. The audience is divided into groups and asked to react on four questions: 1. To what extent would the following activities be desirable? ü systematic exchange of information ü further development and implementation of the two tools ü mapping current research programmes and activities ü identify gaps, overlaps and possible synergies ü analysis of barriers that hinder transnational co-operation ü experimental joint activities, clustering of research projects, personnel exchange, identification

of new opportunities in research, joint evidence databases, capacity building for HP intervention research

ü implementation of a joint work programme ü link to policy making

2. Consortium Authority ü What are the links of the GEP Consortium partners with national research programmes

(strategy and budget) in the field of public health? Would it be possible to increase those links?


3. Consortium: degree of formalization ü To what extent should the Consortium formalize issues such as management, decision-

making processes, division of tasks and resources, management of potential EC funding, arrangements for intellectual property rights?

4. Consortium Coordination ü Do we want to establish our own Consortium and identity or should we merge into existing

structures (HEN, EuroHealthNet, others?) Reporting back on the brainstorm:

- identity crisis: where are we now, where are we heading? Questions to be resolved - Give direction how to use infrastructure - Should not be called Evidence Consortium, but Getting evidence into and out of

practice - Add component evidence into policy - Build on two existing links, IUHPE and GPHP programme - Three networks together can be the basis - Basis on which to base long lasting consortium - Network also future basis - Take on other challenges later on, not now

Jan Bouwens summarizes the results of the first discussion group: - link the name to the message - include policy phase in next phase

Hans Saan:

- be aware of differences in all countries, because of mixed feelings - do not only offer tools, but also support them in their relations to the work in the

country - consortium should also spread the news on public health for networking at European

level - Public Health conference (for both public health and health promotion) - Not too formal, strong formal core is necessary, but let people make it work - Topic important enough to put consortium forward for 3-4 years - Evidence is not enough

Erica Wimbush: - unique role was discussed. Joining Forces Working Group is recently formatted

(Bosse Pettersson), project should link up with them as well. - Two things: to provide coordination function of use AND work together in different

countries. - Developing skills (practical side) in countries - Develop (European) Training Centre - Make it more official - Make it for policy and practice - Access to existing evidence (database) - Look back at experiences and use them (also on the database) - Validating the evidence and sharing - Stress accessibility and have a broad concept

Caroline Costongs summarizes: - clear about direction - evidence into/out of practice - use existing structure as a basis (EuroHealthNet en EHN) - be as formal as necessary - broader base - dilemma public health/health promotion - share with Joint Forces initiative now and do not wait 2-3 years.

Final remarks: - no distinction in the role of partners/active members in a next phase, they will all be called member.


- time investment will be 70 days for the 2-year-project period. This investment should be seen as country investment, not an organization investment per se. Closure Jan Bouwens closes the GEP pre-conference meeting, thanking all participants for their contribution in the 18 months’ duration of the project. There will be some finishing work being carried out during July-August, after which the instruments will be made available. The members will be kept informed through email, newsletters and the website www.nigz.nl/gettingevidence.

LIST OF PARTICIPANTS Pre-conference meeting project GETTING EVIDENCE INTO PRACTICE Venue: Stockholm City Conference Centre, Drottninggatan 71B, Stockholm, Sweden Tuesday afternoon May 31, 2005 13.00-18.00 pm Wednesday morning June 1, 2005 9.00-12.00 am (in alphabetical order of country)


Name contact person and director + email addresses

Institute address + website

Tel and fax

Austria Interested partner

Dr. Petra Pflunger [email protected]

Austrian Health Promotion Foundation Mariahilferstrasse 176 1150 Vienna

Tel: +43 1 8950400-19 Fax: +43 1 8950400-20

Belgium VIG=Strandleader Strand II and Member Steering Group

Dr. Stephan Van den Broucke [email protected] Caroline Bollars [email protected]

Flemish Institute for Health Promotion (VIG) Schildknechtstraat 9 B-1020 Brussels www.vig.be

Tel: +32 2 422 49 49 Fax: +32 2 422 49 59 Tel: +32 477 63 31 09

Belgium EuroHealthNet Communications Member Steering Group

Caroline Costongs [email protected]

EuroHealthNet Rue Philippe Le Bon 6 B-1000 Brussels www.eurohealthnet.org

Tel: +32 2 2350 320 Fax: +32 2 23 50 339

Czech Republic

Hanna Drahonovska [email protected]

National Institute of Public Health, Centre of HP Srobarova 48 100 42 Prague 10 www.szu.cz

Tel: +420 2 67082969 Fax: +420 2 6731 02 91

Denmark

Dr.Tine Curtis Programme research director [email protected]

Danish National Institute of Public Health Centre for Health and Society Oster Farmagsgade 5 DK-1399 Copenhagen-K. www.niph.dk

Tel: + 45 39 20 77 77 Fax: +45 39 20 80 10 Tel:+ 45 35326345 Fax: +45 39208010

Denmark

Dr.Birgitte Gade Koefoed, staff specialist [email protected]

National Board of Health Islands Brygge 67; P.O. Box 1881 DK-2300 Copenhagen S www.sst.dk

Tel: +45 72 22 74 45 Fax: +45 72 22 74 13

Denmark

Dr. Christiane Stock, ass.prof. [email protected]

University of Southern Denmark Dept of Health Promotion Research, Niels Bohrs Vej 9 DK-6700 Esbjerg www.sdu.dk

Tel:+45 6550 4210 Fax:+45 6550 4283 tel: +45 655 04157 Fax: +45 655 04283





Tel and fax

Estonia Interested partner

Dr. Maarike Harro, MD, PhD, director [email protected]

National Institute for Health Development Hiiu 42 EE 11619 Tallinn

Tel: +372 659 39 999 Fax: +372 659 39901

Estonia

Mrs. Anu Kasmel , MD, MSSc Board member [email protected]

Estonian Union for Health Promotion Lumiku 5 11913 Tallinn

Tel: +372 51 05 621 Fax: +372 62 79 281

Finland KTL =strandleader Strand I and Member Steering Group

Mrs Arja Aro senior advisor [email protected] Sanna Räty, physiotherapist/researcher [email protected]

National Public Health Institute KTL Dept.of Epidemiology and Health Promotion Mannerheimintie 166 FIN-00300 Helsinki www.ktl.fi


Finland ABSENT PARTNER

Mika Pyykko, Executive Director [email protected]

Finnish Center for Health Promotion Karjalankatu 2 C 63 FIN-00520 Helsinki www.health.fi

Tel: +358 9 7253 0332 Fax: + 358 9 7253 0320

France

Stephanie Pin (Strand I) [email protected] Fabienne Lemonnier (Strand II) [email protected] Département outils pédagogiques

Institut National de Prévention et d’Education pour la Santé 42 Blvd. de la Libération F-93203 ST. DENIS CEDEX www.inpes.sante.fr

Tel: + 33 1 49 33 2257 Fax: + 33 1 49 33 23 90 Tel: +4755583251 Fax: +4755589887

France ** IUHPE=strandleader Strand III and Member Steering Group

Catherine Jones [email protected] Maurice Mittelmark, president IUHPE [email protected] [email protected]

IUHPE 42 Blvd. de la Libération 93203 ST. DENIS CEDEX www.iuphe.org Research Centre for Health Promotion University of Bergen Christies gatan 13 N-5007 Bergen, Norway

Tel: + 33 148 13 71 25 Fax: + 33 148 09 17 67

Germany ABSENT PARTNER

Volker Stander , social scientist [email protected] Helene Reemann [email protected] Dr. Elisabeth Pott, director [email protected]

Bundeszentrale für Gesundheitliche Aufklärung Ostmerheimerstrasse 220 51109 Köln www.bzga.de

Tel: +49 221 89 92 330 Fax: +49 221 89 92 300 Tel: +49 221 89 92 349 Fax: +49 221 89 92 359

Greece

Yannis Tountas, director [email protected] (ISPM)

Institute of Social & Preventive Medicine ISPM 25 Alexandroupolos Street 115 27 Athens www.neahygeia.gr

Tel: +30 210 748 20 15 Fax: +30 210 748 58 72

Hungary Absent Interested partner

Veronika Farkas: [email protected] dr. Nagy Zsolt : [email protected] Mrs. Agnes Czimbalos

National Institute for Health Development Andrássy str. 82. H-1062 Budapest

Tel: +36-1-4288-278 Tel/fax: +36-1-4288-241





Tel and fax

Ireland (Dublin & Belfast) INTERESTED PARTNER

Dr. Jane Wilde, director [email protected]

Institute of Public Health in Ireland, Forestview Purdy’s Lane Belfast BT8 7ZX Northern Ireland www.publichealth.ie

Tel: +44 28 9064 8494 Fax: +44 28 9064 6604

Italy Absent member

Giancarlo Pocetta, researcher [email protected] [email protected]

Experimental Centre for Health Education Univerity of Perugia Via del Giochetto CP n 1435, 06126 Perugia www.unipg.it/csesi/eng

Tel: +39 75 585 73 01 Fax: +39 75 585 7317

Latvia

Ineta Zirina, director [email protected]

Latvian Health Promotion Centre, 3 Skolas street Riga LV-1010 www.vvva.gov.lv

Tel: +371 72 4 04 47 Fax: + 371 72 4 04 22

Lithuania Absent Interested partner

Mrs. Ingrida Skridailiene Head of International Relationship [email protected]

Ministry of Health Lithuania Division State Public Health Service Kalvariju 153 LT-08221 Vilnius

Tel: 00370- 52778036 Fax: 00370- 52778093

Netherlands NIGZ Coordinating organisation and chair Steering Group

Gerard MOLLEMAN Project leader [email protected] Hans Saan, senior advisor [email protected] Jan Bouwens, Project co-ordinator [email protected] Mrs. Vivian Bos (strand I): [email protected] Henriëtte Kok (strand II):[email protected] Marianne Smit, project assistant [email protected]

Netherlands Institute for Health Promotion and Disease Prevention P.O. Box 500 3440 AM Woerden www.nigz.nl

Tel: +31 348 437 621 Fax: +31 348 437 625 NIGZ-GEP Secretariat: Tel: +31 348 438 853 Fax: +31 348 437 666

Portugal ABSENT PARTNER

Pedro Ribeiro da Silva [email protected]

General Directorate of Health Alamada D. Alonso Henriques 45 1049-005 Lisboa www.dgsaute.pt

Tel: + 351 218430500 Fax: + 351 218430530

Slovakia

Dr.Zora Gerova, MD Head Physician of the Community Health Promotion Centre [email protected]

National Public Health Institute Trnavská 52 826 45 Bratislava www.uvzsr.sk

tel: +4212 52961121 fax: +4212 52961124

Slovenia Interested partner

Dr.Igor Krampač,med.,spec, head of the Regional Centre PH and HP [email protected]

Regional Institute of Public Health Maribor Centre of Public Health and Health Promotion Prvomajska No. 1, 2000 Maribor, Slovenia

Tel: 00386 24602317, mobile: oo38641741 536 Fax: 00386 24622234

Slovenia Interested partner

Branka Dukic, BSc, researcher [email protected]

Institute for Public Health Ljubljana Dept.for Publishing, Research and Education Zaloska 29 1000 Ljubljana

Tel:+38615863900 Fax: + 38615403190





Tel and fax

Sweden

Mia Danielsson [email protected]

Swedish Institute for Public Health (SNIPH) Research Department Olof Palmes Gata 17 S-10352 Stockholm www.fhi.se

Tel: +46 8 5661 35 73 Fax: +46 8 5661 35 05

Spain ABSENT PARNTER

Begona Merino Merino [email protected]

Ministry of Health Paseo del Prado 18-20, 28071 Madrid www.msc.es

Tel: + 34 91 5964194 Fax: + 34 91 5964195

Switzerland

Marlène Läubli Loud Head of Evaluation Resource and Management Centre [email protected]

Swiss Federal Office of Public Health Schwarztorstrasse 96 CH- 3003 Bern Buro: Schwarzenburgstrasse 165, 3097 Liebefeld www.bag.admin.ch

Tel: +41 31 323 87 61 Fax: +41 31 322 99 00 Tel: +41 31 324 1787 Fax: +41 31 322 99 00

Switzerland

Ursel Broesskamp-Stone, Head International Affairs and evidence [email protected] Mr. Günter Ackermann [email protected]

Health Promotion Switzerland Dufourstrasse 30 Postfach 311 CH 3000 Bern 6 www.gesundheitsfoerderung.ch

Tel: +41 31 3500425 (-04) Fax: +41 31 368 17 00

United Kingdom Brighton IHDRC

Caroline Hall, MA BSc [email protected]

International Health Development Research Centre c/o Faculty of Health, University of Brighton, Falmer, Brighton BN1 9PH United Kingdom www.brighton.ac.uk/health/ihdrdc

Tel: +44 1273 644168 Fax: +44 1273 643324

United Kingdom NICE

Dr Catherine Swann Senior Research Specialist [email protected] Antony Morgan [email protected]

National Institute for Health and Clinical Excellence (NICE) MidCity Place 71 High Holborn London WC1V 6NA www.nice.org.uk

Tel: +44 20 7067 5800 Fax: +44 207 7067 5801 Swann: +44 2070613170


Dr.Erica Wimbush [email protected]

Health Scotland Woodburn House Canaan Lane Edinburgh EH10 4SG www.hebs.scot.nhs.uk

Tel: +44 131 536 55 88 Fax: +44 131 536 55 02

United Kingdom Wales ABSENT PARTNER

Dr.Nina Parry-Langdon [email protected]

Research and Evaluation Branch Welsh Assembly Government Cathays Park Cardiff CF10 3NQ www.wales.gov.uk

Tel: +44 29 208 26 522 Fax: +44 29 2082 5779





Tel and fax

United Kingdom

Dr. Viv Speller, consultant [email protected]

Health Development Peacehaven, Uplands Road Denmead, Waterlooville Hampshire, PO7 6HE, UK

Tel: + 44 2392 232 741

EVALUATION OF THE PROJECT GETTING EVIDENCE Evaluation of the project

Mrs. M. Grishchenko [email protected]

Academic Medical Centre Dept.of Social Medicine Room J2-215, P.O. Box 22660, 1100 DD Amsterdam The Netherlands

Tel: +31 20 566 4892 Fax: +31 20 566 2316

** invitees from IUHPE’s Global Programme of Health Promotion Effectiveness present at some point during the pre-conference and/or at the evening dinner,, - Sylvie Desjardins, Acting Director, Policy Research Division, Strategic Policy Directorate, Public Health Agency of Canada, email: [email protected] - Marcia Hills, Co-Leader for the North American Effectiveness Project, email: [email protected] - Marie-Claude Lamarre, IUHPE Executive Director, email : [email protected] - Albert Lee, Regional Leader and Coordinator for Northern Part of Western Pacific Effectiveness Project, email: [email protected] - David McQueen, Global Programme Leader, email: [email protected] - Simon Carroll, Centre Co-ordinator: Research Projects, The Centre for Community Health Promotion Research, University of Victoria, email: [email protected] - Marie DesMeules, Chief, Population Health Assessment, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, email: [email protected] - Alison Jetté, Senior Policy Research Analyst, Policy Research Division, Strategic Policy Directorate, Public Health Agency of Canada, email: [email protected]

This report was produced by a contractor for Health & Consumer Protection Directorate General and represents the views of thecontractor or author. These views have not been adopted or in any way approved by the Commission and do not necessarilyrepresent the view of the Commission or the Directorate General for Health and Consumer Protection. The EuropeanCommission does not guarantee the accuracy of the data included in this study, nor does it accept responsibility for any use madethereof.

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