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Contents

Preface ix Acknowledgements x Glossary xi Part 1 Introduction and context 1 1 The big picture: The context for a textbook on public health nutrition practice 3 Why develop a public health nutrition textbook? 3 Malnutrition is still the main game 3 Innovative solutions are needed 4 Surely you don't mean these challenges can be found in rich countries like mine? 4 Level of influence 5 Practice informed by a public health approach 5 First, work to understand the causes, by looking upstream 5 Practitioners and politics 6 The philosophy underpinning this book 6 Building capacity for effective public health nutrition action 7 2 Defining public health nutrition as a field of practice 9 Introduction 9 Modes of nutrition practice 10 Definitions of public health nutrition 12 An emphasis on the prevention of food and nutrition problems 12 The core functions of the PHN workforce 15 Competencies for PHN practice 17 Professionalism and PHN practice 18 3 A framework for public health nutrition practice 21 Introduction 21 A socio-ecological approach to practice 21 The PHN practice cycle 22 Recognising the importance of capacity building as a discrete strategy and as an approach to practice 23 Why make things more complicated and introduce a new framework? 25 A bi-cyclic framework for public health nutrition practice 28 Part 2 Intelligence 29 4 Step 1: Community engagement and analysis 31 Introduction 33 What is a community? 33 Why Community engagement? 33 Community development constructs 34 Community development - a process or an outcome? 36 Building community capital (and capacity) 37 Building capacity via 'bottom-up' practice 38 Community analysis 40 5 Step 2: Problem analysis 43 Introduction 45 Public health intelligence 45 What is Problem analysis? 46 Types of need 47 Conducting a Problem analysis 47 Different methodological approaches to gather intelligence for problem assessment 51 Applying the intelligence and analysis results 53 6 Step 3: Stakeholder analysis and engagement 57 Introduction 59 Why stakeholder engagement? 59 Stakeholder analysis 60 Considerations for Stakeholder analysis 60 Conducting the Stakeholder analysis 61 Organising and presenting Stakeholder analysis data 63 Stakeholder engagement 67 Engaging stakeholders in decision-making 67 7 Step 4: Determinant analysis 71 Introduction 73 Analysing determinants 73 Characterising determinants by their effect 74 Characterising determinants by the type of causal link 75 Characterising determinants by level 76 Determinant interaction and causal pathways 77 Diagrammatic illustration of determinant analysis 79 8 Step 5: Capacity analysis 81 Introduction 83 What is capacity? 83 A framework for capacity building practice 84 Capacity assessment for capacity building 84 Challenges in measuring capacity 86 Selecting tools for Capacity analysis 86 Tools and strategies for analysing capacity 89 Presenting Capacity analysis data 96 9 Step 6: Mandates for public health nutrition action 99 Introduction 101 Mandates for action - the policy context 101 Policy development - an overview 102 The challenge of competing policy agendas 103 National food and nutrition policies 104 Mandates for action - direct relevance to PHN practice 104 10 Step 7: Intervention research and strategy options 107 Introduction 109 Strategic frameworks for health promotion 109 Determinants as leverage points for intervention 113 Levels of intervention 113 Settings as a focus for intervention 113 Target groups as a focus for intervention 115 Intervention research: learning from earlier work 116 Abstracting intelligence from intervention research 117 11 Step 8: Risk assessment and strategy prioritisation 121 Introduction 123 Assessing risks and benefits 123 Types of risks and benefits 125 Strategy prioritisation 125 Challenges and dilemmas in strategy prioritisation 126 Methods for strategy prioritisation 127 Part 3 Action 137 12 Step 9: Writing Action statements 139 Introduction 141 Intervention planning 141 Action statements 142 Linking problem and determinant analysis to Action statements 142 Writing intervention goals 144 Writing intervention objectives 145 13 Step 10: Logic modelling 151 Introduction 153 What is a logic model? 153 Types of logic model 154 Logic model elements 155 Logic modelling in PHN practice 156 Developing a logic model 157 Key questions for reviewing logic models 157 14 Step 11: Implementation and evaluation planning 161 Introduction 163 Engaging stakeholders in intervention and evaluation planning 163 Planning for intervention implementation 164 Developing work package plans 166 Work scheduling - developing a Gantt chart 168 Developing intervention budgets 169 Evaluation planning 172 Levels of evaluation 173 Developing evaluation indicators and plans 175 15 Step 12: Managing implementation 179 Introduction 181 Types of PHN intervention implementation 181 Governance 182 Managing risk 185 Partnership satisfaction 186 Evaluability assessment 188 Part 4 Evaluation 191 16 Step 13: Process evaluation 193 Introduction 195 Evaluation - a brief overview 195 Linking evaluation to planning 196 Qualitative and quantitative approaches to evaluation 196 Levels of evaluation 197 Process evaluation 197 Elements of process evaluation 198 Methods for conducting process evaluation 202 Process evaluation indicators 202 Process evaluation in practice - some published examples 206 17 Step 14: Impact and outcome evaluation 207 Introduction 209 Impact and outcome evaluation - what is the difference? 209 When to evaluate? 210 Key measures of Impact and outcome evaluation 211 Reliability and validity in evaluation 214 Sampling and data analysis 215 Evaluation design 218 18 Step 15: Evaluating capacity gains 221 Introduction 223 Challenges in measuring capacity 223 Pre- and post-intervention comparisons 226 Strategies to enhance the trustworthiness of capacity evaluation 227 Visual presentations of capacity evaluations 228 19 Step 16: Economic evaluation 231 Introduction 233 Costs and consequences in health care 233 Characteristics of Economic evaluation 233 Types of Economic evaluation 234 Conducting an Economic evaluation 237 Efficiency vs. equity 237 20 Step 17: Reflective practice and valorisation 243 Introduction 245 What is Reflective practice? 245 Transformatory learning and Reflective practice 245 Improving practice through reflection 245 Stages of Reflective practice 246 Methods of Reflective practice 246 Tools for Reflective practice 248 What is valorisation? 249 Targets of valorisation 250 Methods of valorisation 250 Presenting intervention results 253 Appendices 257 1 Intervention plan template 259 2 Capacity building analysis tool 267 References 277 Index 284

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