Creating indicators for social change in public health

© 2018 Dr. Ruth Frances AstonThe goal of achieving social change is a pursuit that traverses sectors, disciplines and levels of society. However, measuring social change, defining the concept and evaluating the impact of efforts to achieve social change is an area where there is much debate, and little empirical knowledge about the effectiveness of social change efforts. This thesis explored and developed proxy indicators for measuring progression towards social change in complex interventions, through a mixed methods concurrent triangulation research design. A narrative literature review in the first phase of the research identified how social change is defined, and what variables could inform the development of proxy indicators. The review findings indicated that intervention design and implementation characteristics are related to intervention effectiveness. From these findings, proxy indicators were developed and tested in a meta-analysis of community-based interventions addressing modifiable cardiac risk factor reduction by acting on the social determinants of health (SDOH). The meta-analysis demonstrated that the indicators could moderate the impact of community-based interventions addressing modifiable cardiac risk factor reduction. A case study of a public health systems intervention, Help Me Grow, then investigated the content validity of the indicators, and the practicality of using them for monitoring and evaluation during intervention implementation. The Help Me Grow case demonstrated that the indicators were both practical and applicable for monitoring the implementation of the intervention, and could be incorporated into a continuous quality improvement system. This thesis has demonstrated that indicators associated with intervention design and implementation are appropriate proxy impact indicators of complex community-based public health interventions, particularly for interventions with long periods of implementation aiming to achieve generational change. Further research is required to test the reliability and other forms of validity of the indicators in sectors and settings outside public health, and identify what measures could be used to gather data on these indicators