Using The Evaluation Process As A Lever For Improving Health And Healthcare Accessibility: A Case Study of HCV Services Organization In Quebec

Abstract:

The field of evaluative research in health is where several trends intersect. The first of these is funding agencies’ intention to ensure research is useful and to promote its use by the various settings involved. This intention finds expression in the requirement to transfer research-based knowledge into practice settings, with key actors’ participation being targeted as a prerequisite for achieving this objective.

The second is the recent trend of interventional research in health, which aims to increase the impact of research results on population health by no longer focusing on the analysis of determinants of health, but rather on public health interventions. The third is the demonstrated synergy between the contextual characteristics of the evaluation environment and the participatory approaches adopted, which explains the use of evaluation results.

These three trends, in complementary but different settings, have led us to rethink the evaluative process, not—as has traditionally been the case—to reach a judgment on the worth and value of an intervention, but rather to use the evaluative process as a lever to improve a problematic situation. The objective of this article is to illustrate how a transformative– participatory evaluation based on an empowerment evaluation approach can contribute to knowledge development while, at the same time, having direct impacts on service provision.

Here we present the case of hepatitis C (HCV) services organization to illustrate the use and the value of this evaluative approach. Hepatitis C, also known as the silent epidemic, is an infection transmitted through blood-to-blood contact. Physicians have access to treatments that can cure 50–80% of cases, including recently introduced treatments that are even more effective with fewer undesirable effects.

Background

The evaluation process can be a lever to improve pathways of access to healthcare. The objective of this article is to show how an evaluation strategy can both contribute to knowledge development and have direct impacts on health services provision. We use the case of hepatitis C (HCV) services organization to illustrate the use and the value of this evaluative approach.

Method

Inspired by empowerment evaluation, the transformative–participatory approach involved overlapping phases of knowledge development and discussion with stakeholders. We conducted several knowledge development activities to discern the needs of people with HCV, the resources available, and the facilitators and impediments along the care pathway, starting from prevention and screening, all the way through to treatment. Using an overlapping approach allowed us to regularly transfer acquired knowledge back to the participants in the study settings and also to gather their impressions, interpretations, and suggestions during periods of deliberation.

Results

The knowledge development activities made it possible to document the needs, resources, and experiences of people affected by HCV. In the discussion sessions, viable solutions were identified to improve health and healthcare access for people with HCV and to prioritize certain actions. This project demonstrated that using the evaluation process can enable an instrumental, conceptual use of results and, in fact, can have a transformative impact on services organization.

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