The sharing health care initiative: Issues in design of the evaluation of a national program of demonstration projects for self-management of chronic conditions

Abstract

This paper aims to consider the key issues in defining and measuring elements for evaluation of the national program of the Sharing Health Care Initiative (SHCI), and to describe the design of the national evaluation framework. Key parts of the chronic disease self-management literature and the evaluation literature were reviewed. The implications of the literature for design of the national evaluation are outlined. Three key issues needed to be addressed in the national evaluation of the SHCI - a program of diverse demonstration projects funded to develop generic self-management approaches. First, a guiding principle of the national evaluation was identification of common project features for analysis against some standard impact and outcome measures, to allow aggregated and comparative analysis. Second, strong emphasis on process evaluation was critical in order to allow analysis of which elements were successful and which were not. Third, the national evaluation was focused more broadly than efficacy at the program participant level; it also covered factors that are likely to contribute to development of self-management programs in the Australian context. The focus of the national evaluation of the SHCI was clearly defined in line with its national role, and reflecting its focus on providing information for future policy options to most effectively develop chronic condition self-management approaches in Australia. Comprehensive evaluation of a range of factors beyond efficacy at the individual client level is needed to assist in understanding the potential effectiveness of population-based implementation of interventions with well-demonstrated efficacy.