Framework for Evaluating Health Promotion
projects: The Swiss Model for Outcome
Classification in Health Promotion and
Prevention (SMOC)
Committee on Valuing Community-Based, Non-Clinical Prevention
Policies and Wellness Strategies
Institute of Medicine, Washington, D.C. , 5
th December 201 1
Brenda Spencer
University Institute for Social and Preventive Medicine, Lausanne
Günter Ackermann
Health Promotion Switzerland
Similar a Framework for Evaluating Health Promotion projects: The Swiss Model for Outcome Classification in Health Promotion and Prevention (SMOC) (20)
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Framework for Evaluating Health Promotion projects: The Swiss Model for Outcome Classification in Health Promotion and Prevention (SMOC)
1. Framework for Evaluating Health Promotion
projects: The Swiss Model for Outcome
Classification in Health Promotion and
Prevention (SMOC)
Committee on Valuing Community-Based, Non-Clinical Prevention
Policies and Wellness Strategies
Institute of Medicine, Washington, D.C. , 5 th December 2011
Brenda Spencer
University Institute for Social and Preventive Medicine, Lausanne
Günter Ackermann
Health Promotion Switzerland
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
2. The SMOC in 2 phrases:
Ø structured framework offering a common language to
describe pathways to health
Ø methodology developed for interactive use integrates the
perspectives of all stakeholders
Ø Plan of presentation
§ Why and how was this model developed?
§ What is the purpose and context of its use?
§ What is its theoretical basis and structure?
§ How is the model applied in practice?
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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3. The Swiss Model for Outcome Classification in Health Promotion
and Prevention (SMOC):
Plan of presentation
§ Why and how was this model developed?
§ What is the purpose and context of its use?
§ What is its theoretical basis and structure?
§ How is the model applied in practice?
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
3
4. Our ever-faithful friend, the black box
Why we think our Our
activities can goal
lead to our goal
Measures
applied: What
we do Improvement
of a population‘s
•Projects health
•Programmes
•Strategies
•Policies
n.b. output is
not outcome!
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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5. It’s never so simple…
Not possible to Not desirable to
standardise standardise measures
measures – adaptation to
context
What’s more, the
Measures context changes over
applied: time
Improvement
of a population‘s
•Projects health
•Programmes Most of these changes
•Strategies you cannot predict
•Policies
And once they’ve And even if you could, you
taken place, you’ll couldn’t control them
need to take
different IUMSP
measures Institut universitaire de médecine sociale et préventive, Lausanne
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6. Various ways to open the
black box…
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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7. A new solution…………….?
"Looks like the research boys really came up
with something this time."
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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8. SMOC Development
§ 2002-2004: Model Construction
§ 2004-2005: Feasibility testing & Translation
§ 2005 onwards: Dissemination
ØGuidelines for use
http://www.gesundheitsfoerderung.ch/pages/Gesundheitsfoerd
erung_und_Praevention/Tipps_T ools/ergebnismodell.php
§ 2008: Publication in Health Promotion International
ØSpencer B, Broesskamp-Stone U, Ruckstuhl B,
Ackermann G, Spoerri A, Cloetta B. et al. 23 (1): 86.
http://heapro.oxfordjournals.org/cgi/content/full/dam038?ijkey=
zQDCckIz8KuMxob&keytype=ref
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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9. The Swiss Model for Outcome Classification in Health Promotion
and Prevention (SMOC):
Plan of presentation
§ Why and how was this model developed?
§ What is the purpose and context of its use?
§ What is its theoretical basis and structure?
§ How is the model applied in practice?
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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10. Three types of application
Situation analysis
Where is a specific problem to be located?
How may the problem have arisen? Intervention planning
T o which categories can the factors
contributing to the development of the How can the health of the
problem be attributed and how do they relate population be maintained or how can a
to each other? health-related problem be reduced?
Are there other players that may already be
having an impact? In which categories should the project’s
objectives be situated and how do the
objectives interact?
Evaluation
Which factors have contributed in which
way to maintain health or reduce health- Applied at three levels:
related problems in the population?
In which categories have results ØProjects
been achieved and how do these results
ØProgrammes
interact?
What do these results tell us about our ØStrategies
hypothesised theory of action?
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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11. The Swiss Model for Outcome Classification in Health Promotion
and Prevention (SMOC):
Plan of presentation
§ Why and how was this model developed?
§ What is the purpose and context of its use?
§ What is its theoretical basis and structure?
§ How is the model applied in practice?
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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12. The determinants of health
Dahlgren G, Whitehead M. Policies and strategies to promote social
equity in health. Stockholm: Institute for Future Studies; 1991.
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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13. Theoretical and Methodological
underpinnings and links
§ Field of Health:
§ Ottawa Charter, 1986
§ Don Nutbeam, 2002; NIGZ Health Promotion Framework
Saan & de Haes 2005; PRECEDE-PROCEED Green &
Lewis, 1986; EUPHID Health Development Model for the
classification of public health indicators Bauer et al., 2006
§ Programmme Theory in Evaluation
§ logic model - “graphic depiction of the relationship between
the main strategies of a program and associated goals,
objectives, population(s) of interest, indicators and
resources” (Hyndman et al., 2001)
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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14. Swiss Model for Outcome Classification
Health promotion Factors influencing Health Health status of the
measures (A) health determinants (B) determinants (C) population (D)
Infrastructures
A1: Development B1: Health
services
of services promoting services
C1: Physical
environment
Legal system A2: Advocacy B2: Public policy
Administration Networking and organisational
Organisation
Networks organisations practice C2: Social
environment D:Health
Groups A3: Social B3: Social potential
Communities
Population mobilization and commitment C3: Indiv. resources/
behavioural patterns
Individuals A4: Development B4: Individual
of individual health-related life
IUMSP
skills skills
Institut universitaire de médecine sociale et préventive, Lausanne
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15. SMOC: Levels of outcome (columns)
and focal points
Health promotion Factors influencing Health Health status of
measures (A) health determinants (B) determinants (C) the population (D)
Infrastructures, services
Legal system, administration, organisations Health
Groups, communities, population
Individuals
IUMSP
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16. Health promotion measures (A)
Health promotion Factors influencing Health Health status of the
Outcome levels
measures (A) health determinants (B) determinants (C) population (D)
Infrastructures
A1: Development
services
of services
A2: Advocacy
Legal system
Administration
Networking
Organisation
Networks
organisations Health
Groups A3: Social
Communities
Population mobilisation
A4:
Individuals
Development of
individual skills
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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17. Factors influencing health determinants (B)
Health promotion Factors influencing Health Health status of the
Outcome levels
measures (A) health determinants (B) determinants (C) population (D)
Infrastructures
A1: Development B1: Health
services
of services promoting services
Legal system A2: Advocacy B2: Public policy
Administration
Organisation Networking and organisational
Networks
organisations practice
Health
Groups
Communities
A3: Social B3: Social potential
Population
mobilization and commitment
Individuals A4: Development B4: Individual
of individual skills health-related life
skills
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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18. B1 Health promoting services
Health promotion Factors influencing Health determinants Health status of the
Outcome levels
measures health determinants population
Infrastructures
Development of B1: Health
services
services promoting services
Legal system Advocacy
Administration
Organisation Networking
Networks
organisations
Health
Groups
Communities
Social mobilization
Population
Individuals Development of
individual skills
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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19. B1 Health promoting services
§ B1-1 Awareness of the service
§ B1-2 Accessibility of the service and reaching of target
groups
§ B1-3 Use of the service and satisfaction with it
§ B1-4 Sustainability of the service
§ B1-5 Improved professionalism in health promotion
– Professionals, mediators
– Population
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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20. B2: Health promoting public policy and
organisational practice
Health promotion Factors influencing Health determinants Health status of the
Outcome levels
measures health determinants population
Infrastructures
Development of B1: Health
services
services promoting services
Legal system Advocacy B2: Public policy
Administration
Organisation Networking and organisational
Networks
organisations practice
Health
Groups
Communities
Social mobilization
Population
Individuals Development of
individual skills
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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21. B2 Health promoting public policy and
organisational practice
§ B2-1 Binding engagement of decision-makers and/or key
persons
§ B2-2 Action-relevant, binding written basis
§ B2-3 Successful organisational changes
§ B2-4 Successful exchange and cooperation
– Policy
– Organisations
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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22. B3 Health promoting social potential
and commitment
Health promotion Factors influencing Health Health status of the
Outcome levels
measures health determinants determinants population
Infrastructures
Development of B1: Health
services
services promoting services
Legal system Advocacy B2: Public policy
Administration
Organisation Networking and organisational
Networks
organisations practice
Health
Groups
Communities
Social mobilization B3: Social potential
Population
and commitment
Individuals Development of
individual skills
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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23. B3: Health promoting social potential
and commitment
§ B3-1 Existence of active groups focusing on health
promoting concerns or themes
§ B3-2 Enlisting of new players
§ B3-3 Awareness of the concern by population groups
§ B3-4 Acceptance of a concern by population groups
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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24. B4 Individual health-related life
skills
Health promotion Factors influencing Health Health status of the
Outcome levels
measures health determinants determinants population
Infrastructures
Development of B1: Health
services
services promoting services
Legal system Advocacy B2: Public policy
Administration
Organisation Networking and organisational
Networks
organisations practice
Health
Groups
Communities
Social mobilization B3: Social potential
Population
and commitment
Individuals Development of B4: Individual
individual skills health-related life
skills IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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25. B4 Individual health-related life
skills
§ B4-1 Factual health-relevant knowledge and capacity to
act on knowledge
§ B4-2 Positive attitudes towards a health-relevant topic
§ B4-3 New personal and/or social skills
§ B4-4 Strengthened self-confidence regarding a health-
relevant topic or an activity
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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26. Health Determinants (C)
Health promotion Factors influencing Health Health status of the
Outcome levels
measures (A) health determinants (B) determinants (C) population (D)
Infrastructures
A1: Development of B1: Health
services
services promoting services
C1: Physical
environment
Legal system A2: Advocacy B2: Public policy
Administration
Organisation Networking and organisational
Networks
organisations practice C2: Social
environment D:Health
Groups
Communities
A3: Social B3: Social potential
Population
mobilization and commitment C3: Indiv. resources/
behavioural patterns
Individuals A4: Development B4: Individual
of individual skills health-related life
skills IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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27. C1 Health-promoting physical
environment
Health promotion Factors influencing Health Health status of the
Outcome levels
measures health determinants determinants population
Infrastructures
Development of Health promoting
services
services services
C1: Physical
environment
Legal system Advocacy Public policy and
Administration
Organisation Networking organisational
Networks
organisations practice
Health
Groups
Communities
Social mobilization Social potential and
Population
commitment
Individuals Development of Individual health-
individual skills related life skills
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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28. C1 Health-promoting physical
environment
§ C1-1 Reduction of pollution caused by physical-chemical
influences
§ C1-2 Conservation and improvement of natural resources
§ C1-3 Health-promoting installations and products
– Work place, education, school
– Habitation, home
– leasure, mobility
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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29. C2 Health-promoting social
environment
Health promotion Factors influencing Health Health status of the
Outcome levels
measures health determinants determinants population
Infrastructures
Development of Health promoting
services
services services
C1: Physical
environment
Legal system Advocacy Public policy and
Administration
Organisation Networking organisational
Networks
organisations practice C2: Social
environment Health
Groups
Communities
Social mobilization Social potential and
Population
commitment
Individuals Development of Individual health-
individual skills related life skills
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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30. C2 Health-promoting social
environment
§ C2-1 Social support, social networks, social integration
§ C2-2 Social climate
§ C2-3 Equal access to general social resources
– Work place, education, school
– Habitation, home
– Leasure, mobility
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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31. C3: Health-promoting individual
resources and behavioural patterns
Health promotion Factors influencing Health Health status of the
Outcome levels
measures health determinants determinants population
Infrastructures
Development of Health promoting
services
services services
C1: Physical
environment
Legal system Advocacy Public policy and
Administration
Organisation Networking organisational
Networks
organisations practice C2: Social
environment Health
Groups
Communities
Social mobilization Social potential and
Population
commitment C3: Indiv. resources/
behavioural patterns
Individuals Development of Individual health-
individual skills related life skills
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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32. C3: Health-promoting individual
resources and behavioural patterns
§ C3-1 Health promoting individual skills
§ C3-2 Improved health-relevant behaviour and
patterns of behavioural
– Work place, education, school
– Habitation, home
– Leasure, mobility
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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33. D: Improvement of a population´s health
and quality of life
Indicators regarding:
§ Increased healthy life
expectancy
§ Increased health-related
quality of life
§ Lower morbidity
§ Less premature mortality
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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34. The Swiss Model for Outcome Classification in Health Promotion
and Prevention (SMOC):
Plan of presentation
§ Why and how was this model developed?
§ What is the purpose and context of its use?
§ What is its theoretical basis and structure?
§ How is the model applied in practice?
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
34
35. Elderly in the community : situation analysis
Neighbourhood
Health promoting construction
Development of services
services unfavourable to elderley
C1: Physical
pedestrians
environment
Absence of public
Public policy and
Advocacy
Networking policy
organisational Institutionalisation
organisations practice Social isolation Poor Quality of Life
C2: Social Health
Loneliness
environment Frailty
Insecurity
Social mobilization Social potential and
Low public
commitment
awareness C3: Indiv. resources/
behavioural patterns
Development of Individual health- Low physical
individual skills related life skills
Fear activity
Resignation
IUMSP
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36. Elderly in the community : programme theory
Apartment rented as
Health promoting small community centre
Development of services
services Project Agenda 21 for C1: Physical garden
Neighbour
community garden environment
activities
Seek
Advocacy Public policy and
partnerships
Networking Joint organisational
project with Elderly live
organisations municipality: QoL
practice Increased social independently
C2: Social Health
Residents of contact
environment Increased strength
ProSenectute all ages Intergenerational Less depression
Social mobilization Social potential and
community Residents understanding
participate in commitment
development design and Community group C3: Indiv. resources/
project created behavioural patterns
construction
Development of Individual health- Increased
of garden
individual skills related life skills physical activity
Increased
confidence
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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37. Outcome model of a prevention project on obesity in infants
Development and Broad dissemination, wide use by
maternal consultants
Dissemination
A1 B1
Development of health
High attainment Health promoting services
Parental satisfaction, few
of target groups
promoting services and many coachings
Acquisition dropouts C1
Health promoting physical
Tools Improved expert skills environment
Further education
B2
A2 Committed promoting public policy and
Health
Advocacy, cooperation of consultantsorganizational practice
organizations C2
Networking with Health promoting social/societal
pediatrics
Successful cooperation
environment D
Improved eating culture Health
B3
A3 Health promoting social potential and
Family meals, slow food, eating without
distraction/TV,…
Social mobilization commitment
C3
Health promoting individual
Improved eating behavior
resources and behavioural
A4 B4 More fruits, vegetables and salads, less
patterns
sweets,snacks and sweet beverages. Increased
Development of Health-related Improved
life skills consumption of sugarless beverages
Coachings individual skills Healthy weight
educational
by parent Improved educational behaviour
counsellors skills Increased physical activity
Increased activity outdoors, less computer and
IUMSP
television
Measures Objectives Institut universitaire de médecine sociale et préventive, Lausanne
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38. Outcome model of a prevention project on obesity in infants:
How many parent counsellors research questions
have
Development and been reached?
Broad dissemination, wide use by
Dissemination
A1 maternaal consultants Which parents
B1 can be reached? few
How good is the quality target groups services
Development of health
High attainment Health promoting
of
Parental satisfaction,
promoting services and many coachings
Acquisition
of the training?
dropouts C1
Health promoting physical
Tools Do the
parent counsellors
Improved expert skills environment
Further education have better skills due to the
B2trainings?
A2 Committed promoting public policy and
Health Was it possible to change
Advocacy, cooperation of consultantsorganizational practice
organizations
Is the networking with C2 eating culture of the
the
families?
Networking with Health promoting social/societal
pediatrics successful?
pediatrics
Successful cooperation
environment D
Improved eating culture Health
B3
A3 Health promoting social potential and
Family meals, slow food, eating without
distraction/TV,…
Social mobilization commitment
Quality of the What is the influence on Do children eat
T o what extent has C3
coaching? parental attitudes and healthier?
educational behaviour eating individual
Health promoting behavior
Improved
skills? resources and behavioural Decrease of
A4 B4 changed? fruits, vegetables and salads, less
More
patterns
sweets,snacks and sweet beverages. Increased
body weight?
Development of Health-related Improved
life skills consumption of sugarless beverages
Coachings individual skills Healthy weight
educational
by parent Improved educational behaviour
councellors skills More physical activity
More activity outdoors, less computer and
Are they more
IUMSP
television
active? sociale et préventive, Lausanne
Institut universitaire de médecine
38
39. Stakeholder Workshop Process
§ Participation:
§ within stakeholder groups
§ between stakeholder groups
§ Communication:
§ implicit becomes explicit
§ exchange and clarify
§ agree on transparent objectives
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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40. Foto
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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41. IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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42. An iterative process…
but
nonetheless
with outputs…
IUMSP
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43. Overall process leading to the definition of an
evaluation framework
Ø Situation analysis
Ø Programme theory
Ø Choice of « priority » objectives
Ø Definition of relevant/key indicators
Ø Definition of corresponding anticipated values
§ quantitative
§ qualitative
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
43
44. Elderly in the community : possible indicators
Apartment rented as
Health promoting Maintenance of
small community centre
Development of services
services
garden
C1: Physical garden
Neighbour
Frequency of activities
Project Agenda 21 environment
activities
Seek
Advocacy Public policy and
partnerships
Networking Joint organisational
project with Elderly live
organisations municipality
practice Level of satisfaction
Increased social
C2: Social independently
Health
regarding atmosphere
contact
Residents of environment Increased strength
ProSenectute all ages in neighbourhood
Intergenerational
Social potential and Less depression
Social mobilization
community Residents Frequency of contacts
understanding
participate in commitment
development design and Community group
Level of C3: Indiv. resources/
project created behavioural patterns
construction participation
Development of Individual health- Low physical
of garden Level of physical
individual skills related life skills activity
activity
Increased
confidence
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
44
45. Individual programmes and projects do not
need to provide evidence of progress from Epidemiological data
C to D:
Health promotion Factors influencing Health Health status of the
measures (A) health determinants (B) determinants (C) population (D)
Infrastructures
A1: Development B1: Health
services
of services promoting services
C1: Physical
environment
Legal system A2: Advocacy B2: Public policy
Administration Networking and organisational
Organisation
Networks organisations practice C2: Social
environment D:Health
Groups A3: Social B3: Social potential
Communities
Population mobilization and commitment C3: Indiv. resources/
behavioural patterns
Individuals A4: Development B4: Individual
of individual health-related life
IUMSP
skills skills
Institut universitaire de médecine sociale et préventive, Lausanne
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46. IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
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47. Where are we now?
§ Dissemination of use
§ National
§ International
§ Sustainability/ Integration of SMOC into:
§ further education and training
§ technical support system
§ quality assurance methodology (http://www.quint-essenz.ch/en.html)
§ grant management process
§ Multiple uses and levels of application
§ Creation of web-based community of users
§ Links with systems management
IUMSP
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48. Key characteristics of the SMOC
§ Communication and understanding is promoted between
stakeholders
§ Provides synthesis of multiple perspectives
§ Development of common language
§ Acknowledges complexity
§ Brings together different forms of evidence from research and
expert/practitioner knowledge
§ Interventions are developed on a theoretical and evidence-
based framework
§ Hypotheses regarding change theory are made explicit and
can be verified: performance AND learning objectives
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49. Thankyou for
your attention!
IUMSP
Institut universitaire de médecine sociale et préventive, Lausanne
49