Building a systems-thinking community workforce to scale action on determinants of health in New Zealand.

This article describes findings from the evaluation of Healthy Families NZ (HFNZ), an equity-driven, place-based community health initiative. Implemented in nine diverse communities across New Zealand, HFNZ aims to strengthen the systems that can improve health and well-being. Findings highlight local needs and priorities including the social mechanisms important for reorienting health and policy systems towards place-based communities. Lessons encompass the importance of local lived experience in putting evidence into practice; the strength of acting with systems in mind; the need for relational, learning, intentional, and well-resourced community organisation; examples of how to foster place-based 'community-up' leadership; and how to enable responsiveness between communities and local and national policy systems. A reconceptualisation of scaling in the context of complexity and systems change is offered, which recognises that relationships and agency are key to making progress on the determinants of health.

Strengthening prevention in communities through systems change: lessons from the evaluation of Healthy Families NZ.

This article presents the findings from the first 3 years of the evaluation of Healthy Families NZ, a systems-change intervention to prevent chronic diseases in 10 communities. The initiative, which builds on existing prevention activities, aims to strengthen the health prevention system through evidence-driven action to enable people to make good food choices, be physically active, smoke-free and free from alcohol-related harm. Key investment areas are a dedicated systems thinking and acting health promotion workforce, and activating leaders who can influence transformational change. The evaluation to date has found the initiative is being implemented with integrity. Evidence indicates a shift towards greater action on prevention, and the prevention system being strengthened. Maori ownership has been enabled, and prioritizing equity has led teams to utilize methods that amplify diverse local perspectives. There is progress on developing a flexible workforce through adaptive learning, flexible resources, professional development and a responsive National team. There is also progress in activating local leadership and empowering local teams. The initiative design has explicitly taken into account the context of complexity within which it is being implemented. It has evolved to focus on action that can accelerate sharing information and practices within communities, and between policy and decision-makers. Healthy Families NZ and its evaluation have been refunded to 2022. This provides an important opportunity to gather further insight into effective ways to strengthen the community agency and trust needed to promote and deliver evidence-based action on prevention.

Evaluating a community-based public health intervention using a complex systems approach.

Background: This article outlines the methods being used to evaluate a community-based public health intervention. This evaluation approach recognizes that not only is the intervention, Healthy Families NZ, complex, but the social systems within which it is being implemented are complex. Methods: To address challenges related to complexity, we discuss three developing areas within evaluation theory and apply them to an evaluation case example. The example, Healthy Families NZ, aims to strengthen the prevention system in Aotearoa/New Zealand to prevent chronic disease in 10 different geographic areas. Central to the evaluation design is the comparative case method which recognizes that emergent outcomes are the result of 'configurations of causes'. 'Thick', mixed-data, case studies are developed, with each case considered a view of a complex system. Qualitative Comparative Analysis is the analytical approach used to systematically compare the cases over time. Conclusions: This article describes an approach to evaluating a community-based public health intervention that considers the social systems in which the initiative is being implemented to be complex. The evaluation case example provides a unique opportunity to operationalize and test these methods, while extending their more frequent use within other fields to the field of public health.