Part 7: Longitudinal Whole Systems Approach Evaluations

Strand 4: Evidence for a Whole Systems Approach to Obesity

Video

Learning Objectives

After watching this section, you should be able to:

• Describe the design and key findings of the longitudinal process evaluations conducted in Scotland and Northern Ireland
• Explain the enablers and barriers to WSA implementation identified in the evaluation evidence
• Identify practical lessons for implementation drawn from the longitudinal studies

Key Points

• Two longitudinal process evaluations were conducted: one in Scotland (two council areas, two time points) and one in Northern Ireland, both assessing implementation of whole systems approaches to diet and healthy weight
• The Scotland study used interviews, focus groups, and 13 months of sociometric survey data to track how decision-makers and leaders engaged with each other to shape the system
• One Scottish council area followed the Public Health England (Leeds Beckett) guidelines step-by-step; the other did not — providing a natural comparison of implementation approaches
• The PHE guidelines were experienced positively but also as ‘clunky’; stringent adherence was difficult due to staff capacity constraints and turnover — underscoring the need to distribute WSA training across teams, not just one or two individuals
• Partnership and collaboration between stakeholders improved markedly as a result of WSA implementation, with relationships extending across topic areas beyond diet and healthy weight
• A Five Nations network (England, Scotland, Wales, Northern Ireland, Republic of Ireland) supports cross-national learning and sharing between WSA leads
• Northern Ireland developed a ‘Getting Real About Implementation’ tracker tool, enabling sites to document their progress through each phase and pass learning on to new team members

Further Reading

• NIHR PHIRST: Getting RREAL about implementation of a WSA to obesity prevention in Northern Ireland — the project page for the Northern Ireland longitudinal process evaluation discussed in this video, including the RREAL tracker tool approach
• A whole systems approach to obesity prevention: a rapid synthesis of evidence — the full IPH report containing summaries of both the Scotland and Northern Ireland longitudinal evaluations (Breslin et al., 2023)
• Whole systems approach to obesity: a guide to support local approaches (Public Health England / Leeds Beckett, 2019) — the PHE/Leeds Beckett guidance (‘the Leeds Beckett methodology’) that one Scottish council area followed and that is discussed in detail in this video
• Human Learning Systems — a framework for public service organisations to explore, learn and respond to the unique needs of communities; complements the community-centred and co-production principles described in the WSA longitudinal evaluations

---

Knowledge Check

Complete the questions below before moving on.

What was one of the key lessons learned from the longitudinal process evaluation of whole systems approaches conducted in Scotland?

Training in whole systems approaches should be shared across multiple people in an organisation so that implementation can continue if staff move on to other rolesQuantitative data collection methods were found to be more informative than qualitative approaches for understanding implementationThe Public Health England guidelines were found to be straightforward and easy to follow in all council areas studiedWhole systems approach implementation is most effective when led by a single dedicated champion within the council area

The correct answer is training should be shared across multiple people in an organisation. The Scotland evaluation showed that when staff who had received training moved to other positions or were redirected to other areas of work, implementation could be disrupted. The key lesson was that whole systems approach training should not rest with one or two individuals — sharing it across the team ensures continuity if someone moves on. This has since been adopted as a recommendation in the Northern Ireland implementation guidance.

• True
• False — the evaluations relied substantially on qualitative methods (interviews, focus groups, and sociometric surveys) precisely because these are most suited to understanding implementation processes.
• False — the evaluation noted that following the Public Health England guidelines stringently could be experienced as ‘clunky’, and that the process was challenging to follow in full.
• False — distributed leadership across the system, rather than a single champion, is one of the core features of the whole systems approach.

---

← Part 6

Part 8 →