3 THE EVALUATION OF FNP IN SCOTLAND
3.1 Aims and objectives of the evaluation
The overall aim of the evaluation is to assess the implementation of the FNP programme in Edinburgh, and to use the learning from this to assess whether the programme can be implemented in other areas of the country.
The evaluation focuses on three broad questions:
- Is the programme being implemented as intended? If not, why not?
- How does the programme work in Scotland (Lothian)?
- How do Nurses, clients and the wider services respond to the programme?
- What are the implications for future nursing practice?
- What factors support or inhibit the delivery of the programme?
- What is the potential for FNP to impact on short, medium and long term outcomes relevant to Scotland?
3.2 Monitoring and evaluation framework
The evaluation combines analysis of quantitative monitoring data collected by NHS Lothian on the experiences of all 148 FNP clients, and qualitative data collected by ScotCen (the external evaluation team) on a smaller sub-sample of clients interviewed at regular intervals as they progress through the programme.
Following three logic modelling events, which involved key stakeholders from Scottish Government, NHS Lothian and City of Edinburgh Council, it was agreed that the internal monitoring and external evaluation of the test site in Edinburgh for FNP would:
- distil learning on FNP delivery in Edinburgh, including the barriers faced
- explore views on the skills, systems and infrastructure believed to be necessary to implement the programme, and challenges faced in achieving these; and
- contribute to national learning on how the programme (or aspects of it) might be used in the future.
3.3 Overview of research methods
The evaluation research is addressing the objectives set out above using a range of formative and summative approaches, including:
- A review of published and grey literature to inform the evaluation (on-going)
- The development of a monitoring and evaluation framework using a logic modeling approach based around Theories of Change
- Analysis of data collected for all clients using the measures developed for routine monitoring, to assess the implementation of the programme
- Longitudinal qualitative research (case study approach) involving repeat in-depth matched interviews with a panel of up to 15 clients (4 interviews - during pregnancy, 3 months after birth, when their baby is 12 months old, and when their baby is 24 months old), a nominated significant other (2 interviews) and the clients' Family Nurses (2 interviews), at key points during the client's pregnancy and the first two years of her child's life
- Key stakeholder and FNP Edinburgh team interviews at key points to inform and reflect their understandings of the implementation of the programme.
This report focuses on the client recruitment and pregnancy phases of FNP and, hence, on the first interviews with clients, Family Nurses and with key stakeholders. It also draws on monitoring data relating primarily to the client recruitment phase. By the end of the evaluation, however, the following longitudinal data will be available:
- Monitoring information for all clients, from initial engagement to leaving the programme
- Repeat interviews with key stakeholders
- Case studies for 15 clients which will bring together:
- clients' views and experiences of the programme, from their initial engagement with FNP until their child is 24 months old (4 interviews)
- their Family Nurses' views of these clients' involvement with the programme, and of the role the Family Nurses have played with respect to these clients (2 interviews)
- the views and experiences of clients' "significant others" (2 interviews).
3.4 Ethical and NHS approval
Application for ethical approval was submitted to the South-East Scotland Research Ethics Committee. The study was approved May 2010. Application was simultaneously sought for local NHS access and this was received June 2010. Recruitment of clients to the evaluation therefore began after all approvals had been received. This meant that clients who enrolled with FNP in the earliest months of the FNP recruitment phase were not able to be recruited to the evaluation qualitative panel.