AES 2015 International Evaluation Conference

Clancy Read (Telethon Kids Institute, University of Western Australia)

Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) are auto-immune diseases caused by untreated streptococcal infection of the throat. ARF and RHD are largely associated with poor socio-economic living conditions and the disease burden in Australia's Aboriginal populations is among the highest in the world. 
As a consequence of its proven benefit and demonstrated cost effectiveness, secondary prevention is the focus of most RHD control strategies. This involves secondary prophylaxis (SP), the four-weekly administration of penicillin for at least 10 years to all people with a history of ARF or RHD to control and reduce their chance of progressing to established, or more severe disease outcomes. Continued progress in controlling RHD requires an understanding of how to improve delivery of SP.  
Adherence to SP remains unacceptably low in the Northern Territory (NT) of Australia. Between 2007 and 2013 only 24% of clients in the NT received the recommended national target of  ≥ 80% of scheduled injections. Our study aims to improve the uptake of SP by implementing and evaluating a sustainable, transferable, systems-based intervention using a stepped-wedge trial in 10 communities in the NT. The intervention, applied at the health centre level, will adopt the Chronic Care Model (CCM) as a framework for activities which will be implemented over a 15 month period. 
Mixed-method data collected over the course of the study will inform the evaluation of the intervention's effectiveness. This complex intervention requires a solid program theory upon which to base a theory-driven evaluation framework. The evaluation framework explores implementation, action theory and conceptual theory successes and takes underlying causal mechanisms into account when assessing the intervention. It will provide an understanding of whether the intervention meets its goals and document the hows and whys of the intervention's success or failure. The evaluation framework for this study will be showcased in this paper.