Background and Project Plan

The Indigenous Eye Health Unit (IEHU) at the University of Melbourne is currently funded by the Australian Government Department of Health and Aged Care (DoHAC) to provide health promotion activities supporting the sustainable elimination of trachoma as a public health problem in Australia. The current funding agreement ends 30 June 2024.

An evaluation of this work is required as part of the current DoHAC funding agreement and activity work plan for 2023-2024. The evaluation is described as:

An evaluation of the impact of health promotion activities on facial cleanliness in selected communities for the period 1 July 2021 – 31 June 2023. This will include recommendation/s for future health promotion approaches in trachoma and any changes for improvement to current activities, with consideration to efficiency, effectiveness, and appropriateness of the project.

IEHU has been conducting trachoma health promotion since 2009 and has been funded by the DoH to provide health promotion resources and run activities since 2015.

Australia’s efforts to eliminate trachoma are currently at an important stage. The national rate of trachoma has halved since 2011 and is 3.3% in 5 – 9 year old children in 2021 (NTSRU 2021). Recently released data for 2022 shows a further reduction in national prevalence to 2.2%. A dossier seeking certification for the elimination of trachoma in Australia by WHO is expected in the next two to three years.

Aim of the Evaluation

The aim of this evaluation is to establish recommendations for future health promotion approaches in trachoma beyond June 2024 including improvements to current approaches with consideration for efficiency, effectiveness and appropriateness. The evaluation will also consider the impact of health promotion activities in 2021-2023 on facial cleanliness in selected communities.

Method

A desktop review of data and activities in trachoma hotspot communities will be undertaken to explore facial cleanliness in hotspot communities over the calendar years 2020, 2021, 2022. IEHU will undertake a critical internal report and review of activities in the same communities and time frame.

A Delphi method survey will be undertaken to gain consensus advice on effective trachoma health promotion approaches used in trachoma elimination health promotion 2010 to 2022 and advice on recommended future health trachoma elimination health promotion activities for 2024-2027. The Delphi expert consensus method allows for the gathering of practice-based evidence from experts and collaboration amongst key stakeholders to determine best practice (Jorm 2015).

IEHU will establish a small evaluation steering group to guide the evaluation and a small evaluation operations team to manage the evaluation. The steering group will include members providing evaluation expertise and those who are external to IEHU. External consultants may also be engaged to provide support and additional input to the project.

An Aboriginal and Torres Strait Islander reference group will also be established to inform the evaluation and to ensure that the knowledge, systems and frameworks of Aboriginal and Torres Strait Islander people working in the trachoma elimination eco-system are privileged within the evaluation design, implementation and outcomes.

The evaluation steering, operations and Aboriginal and Torres Strait Islander reference groups will be involved in all stages of the evaluation including planning, questionnaire development, ethics (likely needing University of Melbourne and NT Human Research Ethics approvals), Delphi panel recruitment and formation, Delphi consensus survey rounds, data analysis, results and write up.

A list of 50/60 experts working throughout the system will be invited to participate in the survey.  This will allow for input from a wide range of stakeholders involved in different parts of the system. It will also allow analysis of First Nations voice and feedback. Feedback will be provided to the panellists after each round.

We anticipate three rounds of Delphi surveying

Round one: to explore the effectiveness of previous health promotion activities and nominate and identify those activities that are considered effective in future trachoma health promotion

Round two: to identify the priority activities for future trachoma health promotion

Round three (possibly by workshop): to finalise the priority future trachoma health promotion activities.

A written report will be provided to the DoHAC at completion of the evaluation and an interim report of the evaluation will be prepared for DoHAC by 30 March 2024.