Publication
Promoting health improvement and tackling health inequalities: Local authorities perspectives - Evaluation of a pack for trainers
| Contents: | Executive summary 1. Introduction 2. Pre-training findings Acknowledgements 3. Post - training findings 4. Conclusions and recommendations Appendices |
2. Pre-training findings
This chapter provides abreakdown of the key findings which were generated from the four focus groupdiscussions which took place at each local authority setting, prior to trainingdelivery. The purpose of engaging withtrainers at this stage was to ascertain the extent to which the pack supportedthem in preparing for the workshop sessions. This is important as a confidence-building and context-setting tool forfuture trainers and it was therefore important to determine whether the pack -in its current format - can offer the reassurance and clarity required atpre-training stage, in order that trainers can adopt a confident and conciseapproach to training preparation.
When the researchers metwith the trainers, they were at various states of preparation across the foursettings. Some had met on several occasionsto discuss and prepare the workshops while others still had more work todo. As such, findings were quitegeneralised with a fair degree of uncertainty. What was clear across each setting was that all trainers felt that asignificant degree of preparation was required in preparing for delivery - thiswas regardless of experience or background. This was felt to be partially due to the amount of information withinthe pack which was required to be imparted to participants, and also due to thewide range of activities to be covered in the workshop, each requiringdifferent approaches to planning and preparation.
The following tableindicates the key areas which were discussed during the focus group sessions,and allows for easy comparison across the four settings. The use of symbols in the table areabbreviations for the following:
+ positive comment
- negative comment
~ neither positive nor negative comment
In the interests ofconfidentiality, specific research findings within the four local authoritieshave been grouped as Local Authority A, B, C and D.
2.1 Pre-training findings, broken down by local authority area
| Area of Discussion |
Local Authority A |
Local Authority B |
Local Authority C |
Local Authority D |
| Trainers (skills required and self-ratings are based on a scale of 1-5, where 1 is least positive and 5 is most positive) |
Skills Required:
Self Ratings:
|
Skills Required:
Self Ratings:
|
Skills Required:
Self Ratings:
|
Skills Required:
Self Ratings:
|
| Comments:
|
Comments:
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| Structure of the workshop - guidance provided |
+ content is broken-up well - language very wordy and sometimes ambiguous - concerns about lack of clarity for future updating of materials |
+ provides good direction - confusing; not logical; requires 2-3 readings being becoming clear; more preparation time due to poor structure ~ should be grouped by topic throughout, according to sessions and not by different areas of trainer support |
+ good direction and detail; provides reassurance and consistency - language sometimes a bit technical - sequence is not always logical |
~ should be grouped by topic throughout, according to sessions and not by different areas of trainer support |
| Structure of the workshop - adequacy of information |
+ good reference material |
- you would require a basic'grounding' in HI before pack would make sense |
+ national policy context is clear |
~ too much background reading required of trainers and participants; off-putting |
| Structure of the workshop - relevance of aims |
-'Role of Local Authority in Addressing HI Agenda' - not clear |
- aims clear but learning points are a bit ambiguous |
~ will require some'ad-libbing' to get across the key learning points |
+ |
| Structure of the workshop - content addresses aims |
+ |
+ due to prescriptive nature of pack |
+ |
~ Our HI plan is still not tangible enough for participants, which is beyond the control of the pack |
| Activities and Content - pack lends itself to information giving, discussion and sharing ideas and experiences |
|
|
|
|
| Activities and Content - effective'warm-up' |
+ pre-course form and 'Overheard on the Bus' ~ scene setting is very important |
+'Car Park' exercise ~ Group will not need a warm-up activity |
- the pre-course form is good but there is no scope to fully explore. - lack of'ground rules' to ensure participants understand format and the need for fair and active engagement |
- the pre-course form could be quite threatening if not used carefully - seems to go straight into theory without appropriate warm-up |
| Activities and Content - unnecessary / repetitive |
+ (none) |
- Ottawa Charter is unnecessarily detailed - historical development is too long |
- historical development is too long (but the rationale is important) |
+ (none) |
| Activities and Content - too simplistic |
+ (none) |
- Not clear if the'What is Health?' section is perhaps too simplistic |
+ (none) |
+ (none) |
| Activities and Content - too complicated |
- Ottawa Charter - pm strategy planning session |
- Ottawa Charter exercise is confusing |
- weighting process ('What Influences Health in Your Locality - Session 2) - pm strategy planning session |
+ (none) |
| Activities and Content - training methods balanced |
+ |
- perhaps too much presenter-led |
+ |
- too information-intensive in am sessions |
| Activities and Content - good examples and case studies |
+ |
-'Overheard on the Bus'- objectives unclear - Overhead 2 (medical approach to health) is confusing |
+ Broad Street Pump is a good example |
+ |
| Timing |
- will have to cut short some of the discussions exercises - statistical evidence and measuring deprivation needs will require more than 10 minutes |
~'added' time through adapting start and finish times, plus altering breaks |
~ presence of Councillors close to election times could be difficult to manage, due to'discussions' which emerge during workshop - will have to cut short discussion sessions but unclear where other areas could'lose' some content |
- will be tight |
| Scope for change / improvements |
~ pre-course work could include an introduction to Community Planning / partnership working ~ group size should be 12-16 ~ training needs to link with planning structures in own area ~ perhaps pace training over a longer period to allow for consolidation and reflection, as opposed to overwhelming with information |
~ group size about 12 ~ re-order pack as per earlier suggestion |
~ awareness letter from the Chief Executive would send the right signal ~ future targeting will require to get through'gatekeepers' in order to raise awareness of training and wider agenda ~ group size about 14 ~ more time required ~ guidance / pack should be available on disk, to allow for easy searching ~ more use of diagrams / pictorial formats on transparencies and handouts, to demonstrate key points ~ more use of local examples |
~ re-organise pack as per above comments ~ some guidance on how to use existing HI Groups for further dissemination of key messages ~ Group size about 12 ~ take training out to areas where it would be logistically difficult to come to a central location ~ training should be integrated into corporate training |
| Targeting Participants |
~ messages within the pack are more relevant for strategic groups than operational groups ~ pre-course form (adapted) could be returned prior to training in order for trainers to get a better idea of pitching the training |
~ difficult due to current internal reorganisation ~ could develop more impetus through an introductory session from the chief executive |
~ the current group who meet might change membership following the training |
~ could participants be encouraged and guided to use Health Impact Assessments at the end of the workshop, in order to provide focus for action? |
| Strengths, Weaknesses, Gaps and Difficulties Strengths, Weaknesses, Gaps and Difficulties (continued) |
+ good mix of activities - challenge to make it more than an end in itself - more time to deliver and allow for reflection - Ottawa Charter is very new and quite complex - NHS role and involvement appears to be a gap - difficult for delegates to connect to their own roles ~ only 2 trainers will be required if participants are less than 15 ~ training needs to be placed within a Community Planning context |
+ lots of excellent detail in pack - inflexible and not localised ~ will need to make it more relevant and'punchier' |
+ impressed with breadth of coverage + clear consideration of group work and group dynamics + pack is a great start - too much detail - requires follow-up / 'Phase 2' - difficult to get beyond the theory (especially when there is no'How To' manual) - real barriers to sustainability of agenda include funding ~'Ownership' of the HI agenda will be crucial ~ training is a direct challenge to local government culture; managing change ~ staff do feel overwhelmed by change and this new agenda might further contribute to that ~ challenge to make agenda sustainable |
+ pack is coherent - action planning stages will be challenging - should include use of heath impact assessments - will be difficult to cover all content in 1 day ~ internal plans for further roll-out are still unclear |
| Event Organisation |
- training is not currently connected to wider corporate planning and therefore feels 'parachuted' in ~ difficult to incentivise attendance for more operational groups who are currently further'removed' from the HI messages ~ because of internal knowledge and experience of trainers, it was easier to target the key relevant staff |
~ due to the current internal reorganisation, a less strategic group was targeted, with some reluctance to attend |
~ well-planned and orchestrated but took lots of time and required both administrative and corporate support (resource implications) |
~ well-supported at senior and corporate levels |
| Future Delivery / Used as'Stand-alone' |
~ will require significant background work and planning for future trainers ~ will require co-facilitation ~ current uncertainty concerning how this will link to wider Community Planning agenda ~ too early to make confident links between this training and wider capacity building for HI |
~ will require HI support for future delivery (advice, guidance) |
~ understanding the local Community Plan is a pre-requisite for trainers ~ models of health require lots of work for clear understanding ~ need to consider learning objectives for different groups in the future |
~ lots of background work required ~ it would be very difficult for a trainer without a background in HI to deal with information / knowledge based questions ~ trainers require strong overview of local culture and where HI sits within the local authority, in line with wider Community Planning |
| Co-Training Guidance |
+ might be useful for future trainers but contained nothing new for current trainers |
+ might be useful for future trainers but contained nothing new for current trainers |
+ might be useful for future trainers but contained nothing new for current trainers |
+ might be useful for future trainers but contained nothing new for current trainers |
2.2 Summary of pre-training findings
Fromthe above table, the following key issues seem to be the most relevant atpre-training stage:
2.2.1 Skills required and self-ratings of skillsThe key skill areas which weredeemed to be very important for trainers were presenting to senior audiences;pitching delivery appropriately; dealing with difficult issues; presentingeffectively and facilitating group work. Self-ratings tended to vary quite a bit with the lowest self-ratings forthose with no / limited training experience. This suggests that even where a'trainer' possesses a HI background, this might not - by itself - compensatefor a lack of training experience. However, the HI role and input were also deemed to be very important
2.2.2 Structure – guidanceThepack offers good content and general direction, providing trainers withreassurance and consistency. However, it does need reorganising, in order tolink information related to each topic for delivery, and not according to thedifferent areas of trainer support (as is currently the structure)
2.2.3 Structure – adequacy of informationVery good in relation to policyissues and reference material. Someconcerns that the amount of information could be off-putting / daunting forfuture trainers and that a certain'grounding' in HI would be necessary inorder not to feel overwhelmed
2.2.4 Structure – relevance of aimsGenerally very good although moreclarity might be required relating to learning points. (This might be partiallyovercome with pack reorganisation.)
2.2.5 Structure – content addresses aimsYes, but much is dependent onparticipant'readiness' to engage with the material, which relates to how'close' participants are already to the HI agenda and how this is progressingwithin the local setting
2.2.6 Activities and content – information discussion andsharingLots of very good information butperhaps too much. Discussion ideas arevery good but, due to timing, trainers might have to cut short some of thesesessions, which might defeat the purpose of the training. Participants might not be comfortable enoughwith each other to share ideas, depending on how well they already know eachother. However, the material was felt to be sufficiently geared towardsenabling'the penny to drop' with participants i.e. over the course of the dayparticipants would be able to make the relevant connections between what theydo in their jobs and the links to the health improvement agenda. One trainer described an analogy whichexplains this very well:
"When youbuy a red car, you always see red cars"
2.2.7 Activities and content – warm up'Ground rules' are perhaps requiredto set off the day and more extensive use of the pre-course form is necessary(which currently appears not to address the issue of'ice-breaking').'Overheard on the Bus' was felt to be a goodinteractive activity, as well as the'Car Park' activity in the afternoon
2.2.8 Activities and content – unnecessary/repetitiveToo much time spent on, and detailwithin, the Ottawa Charter
2.2.9 Activities and content – too simplisticNone, although the'What isHealth?' session might be perceived this way if not facilitated well
2.2.10 Activities and content – too complicatedThe Ottawa Charter, the weightingprocess from'What Influences Health in Your Locality?' and the strategyplanning session at the end of the day. All felt to require more guidance for effective delivery, focus andfacilitation
2.2.11 Activities and content – training methods balancedYes, but perhaps lesspresenter-led focus and less information throughout would offer a betterbalance
2.2.12 Activities and content – examples/case studiesVery good but some level ofuncertainty as to what the objectives are for'Overheard on the Bus'
2.2.13 TimingFelt to be tight so some sessionsmight have to be cut short, especially discussion sessions
2.2.14 Changes/improvementsThe pre-course questionnaire couldbe more focused and used more effectively in the first session, as well asincluding areas within it about partnership working / Community Planning. More time was felt to be required overalland the pack reorganised. Ideal group size would be twelve to sixteen. Early training promotion from the chiefexecutive through a letter to delegates was suggested as well as using thedelegates in the future for wider promotion of the event. There was felt to be a clear need to ensurethat training is'mainstreamed' into the corporate training calendar, as wellas clear linkages to overall internal planning frameworks. The pack might be more easily updated andused by trainers if on disk and some presentation aspects could includediagrams / pictorial formats, instead of just text. Local examples could also be inserted into material.'Phase 2' or follow-up sessions were felt tobe important in order to consolidate learning and begin to build capacity. It was felt that simplified versions ofhealth impact assessments might also supportthis
2.2.15 TargetingThis was made easier by the'ready-made' groups for training, where these existed. Earlier return of a more focused pre-coursequestionnaire would allow trainers to'pitch' the training more appropriately
2.2.16 Strengths, weaknesses, gaps and difficultiesA good mix of content andactivities which are pitched well to meet a range of needs and learning styles.The strategy planning session was felt to be challenging, as was keeping totimings throughout and working through the Ottawa Charter materials. There was felt to be a need to include localexamples and statistics and to consider how the NHS might contribute to futuresessions.'Phase 2' / follow-up sessions were felt to be crucial, against abackdrop of strong internal'ownership' of the agenda and a clear vision forhow the HI agenda and training are to be made sustainable at local levels
2.2.17 Event organisationSenior support was felt to benecessary in both promoting the training and ensuring its sustainabilitythrough the corporate training calendar. Such support was available to the fourtest sites through a corporate / HR role, either directly through one of thetrainers and / or through more strategic support, whereby trainers reportedback on needs and progress. The'proximity' of the'lead trainer' role (i.e. the HI officer role) to corporatesupport and / or the chief executive's office was felt to be very important inboth organising the training event and in providing longer-term support for thetraining.'Insider knowledge' of the culture, contacts and internal processesfor gaining support were felt to be essential. This links to providing appropriate incentives for participants and alsogetting past'gatekeepers' within service areas who might consciously orunconsciously present barriers to wider participation
2.2.18 Future training/standaloneCo-facilitation was felt to beessential, combining HI expertise with wider training experience. Trainersshould also have a strong grasp of the internal culture and knowledge ofprogress and plans for Community Planning. Sufficient time for building knowledge and planning the training werealso important. Given that this'mix'of skills and abilities is not likely to be common within local settings, thereis probably limited scope for these events to be delivered as'standalone'. A process of buildingcapacity to achieve the skills and behaviours mix mentioned above is likely torequire planning efforts, with resource implications
2.2.19 Co-training guidanceTrainers generally felt that therewas little new in this guidance since most of them came from trainingbackgrounds and had co-facilitated in the past. However, it was felt to beessential for future trainers without co-facilitation experience