Climate change poses urgent and unevenly distributed risks to health, while research on climate and health remains underdeveloped and under-representative of low- and middle-income country contexts. The Advancing Research for Climate and Health (ARCH) global initiative addresses this gap by supporting a regional network of researchers focused on strengthening climate-resilient primary health care and health systems. Because ARCH is designed to build a nascent interdisciplinary field and support systems-level change across diverse contexts, conventional monitoring and evaluation approaches are unlikely to provide the adaptive foresight, learning, accountability and strategic feedback required. This paper presents the design and application of a Dynamic Evaluation approach developed for ARCH to support collective learning, adaptation and responsible scaling, and scaling science in complex climate-health systems. Drawing on the International Development Research Centre (IDRC)’s work to cultivate the field of Scaling Science, the ARCH initiative implements DE by cultivating a mindset of collective and inclusive learning across multiple levels, using a decentralized, participatory process through working groups and aligning with a nested Theory of Change. The DE framework is structured around four core components: purposes, priorities, people and processes. These components define learning purposes that go beyond conventional learning and accountability functions, identify "springboard" learning questions to guide evaluative enquiry, establish participatory learning and governance arrangements across local, regional and global levels, and create adaptive processes for foresight reflection, sense-making and accountability. The framework also recognizes the ethical and capacity considerations required to support inclusive participation and adaptive decision-making in complex systems. Drawing on examples from ARCH's regional hubs (West and Central Africa, East and Southern Africa, Asia, Latin America and Caribbean, and the Middle East and North Africa), we illustrate how DE operationalizes a continuous cycle of conjecturing, reflection, sense-making and accountability. Dynamic Evaluation is a novel approach that moves beyond extractive, top-down, snapshot evaluations toward the cultivation of a functioning learning system across hubs, projects and programme governance spaces. In ARCH, DE is designed to strengthen the collective, ongoing learning “evaluative muscle” required to understand emerging change, use evidence to support impact at scale, adapt strategies in complex climate-health systems, distribute learning across local, regional and global actors, and connect learning to decision-making and accountability by making visible progress, uncertainty, trade-offs and adaptation. However, established literature on communities of practice, boundary crossing and adaptive development also highlights risks: learning processes may remain performative, become compliance exercises, fail to bridge institutional and disciplinary boundaries, or be constrained by funder expectations, incentives, time and capacity. The value of ARCH DE will therefore depend not only on the existence of learning processes but also on whether these processes create the trust, autonomy, feedback loops and decision space needed for evidence to shape strategy, relationships and scaling choices.
Logic models are useful tools for evaluating complex interventions, but methods for collaboratively developing them with key stakeholders are rarely reported. We describe innovative methods used to co-produce a logic model for Creative Minds, an NHS-based charity supporting community creative activities for mental health service users. We held three online consensus meetings with 18 stakeholders including Creative Minds staff and community partners. An initial logic model draft was iteratively refined through real-time collaborative editing during meetings. Additional feedback was gathered via a conference poster. Researchers reviewed and synthesised inputs after each stage. Stakeholders readily engaged with the process, expanding and refining the initial logic model in real time through live amendments. Key challenges included capturing mechanisms and linkages and managing differing stakeholder perspectives. The resulting logic model provides a comprehensive representation of the Creative Minds approach ready for field testing. Our collaborative online approach enabled meaningful stakeholder involvement in the development of a complex intervention logic model. This contributes to expanding methodologies for co-producing logic models and evaluating social prescribing interventions. Further research is needed to refine methods for capturing causal mechanisms in logic model co-production. The co-produced logic model will support the implementation and evaluation of creative approaches in NHS mental health services. Creative Minds is a charity based in an NHS mental health trust that aims to support people using the trust service with community based creative and sporting activities that are suitable and welcoming. In this paper, we discuss how we worked with a group of people to better understand how Creative Minds is meant to work. We did this using a logic model. A logic model is a picture or visual plan that usually describes the resources needed, the activities that take place and the changes people hope the programme will bring about. We held three online meetings with 18 people, including staff from Creative Minds and the people who organised and run the community activities. We started with a rough draft of the model and worked together to make it better during the meetings. We also received more feedback from a poster at a conference. After each step, we reviewed everyone’s ideas and updated the model. The group made many improvements, adding new ideas and showing how different parts of the logic model fit together. Some of these suggestions were simple, while others were more complicated, and it was not always easy to explain everything. Where people did not agree group processes allowed these perspectives to be explored and resolved. By the end, we had a detailed model of how Creative Minds works, which we can use to test how Creative Minds runs in real life.
Abstract Background Performance measurement plays a central role in governing healthcare system reforms, yet defining what should be monitored is often challenging in complex and decentralized systems. Rather than functioning as neutral tools, performance indicators shape how reform priorities become visible and governable within reform processes. While previous research has examined the design and effects of performance measurement systems, less is known about how follow-up priorities are negotiated when broad reform ambitions are translated into local governance. This study explores how municipal stakeholders negotiate what should become measurable during the implementation of a large-scale healthcare reform. Methods An interpretive descriptive approach was used. Data were generated through nine stakeholder workshops involving 191 participants across municipalities in Västra Götaland County, Sweden and analysed using an abductive thematic analysis. Participants included politicians, managers, civil servants and healthcare and social care professionals. The workshops explored existing indicators, information gaps and the conditions required for meaningful follow-up of the ongoing transition towards Close Care, a national reform aiming to strengthen primary care and develop more person-centred services. Results Four closely related empirical patterns were identified and, through abductive interpretation, synthesized into a conceptual framework comprising normative, conceptual, infrastructural and epistemic conditions shaping the feasibility of measurement-based governance. First, stakeholders negotiated why, for whom and how measurement should be used, reflecting tensions between accountability, quality improvement and learning. Second, conceptual ambiguity regarding the reform’s governing object made it difficult to determine what should be measured. Third, fragmented data infrastructures limited the availability and comparability of indicators. Fourth, limited epistemic capacity constrained how available data could be understood and used for governance and improvement. Conclusions Rather than viewing tensions between reform ambitions and measurement feasibility as implementation failures or resistance to measurement, the findings suggest that such tensions are inherent features of governing complex healthcare systems. By examining the governance processes through which “what matters” is negotiated before becoming measurable, the study highlights measurement itself as a central governance process. Before performance measurement can guide governance, organizations must establish the normative, conceptual, infrastructural and epistemic conditions that enable measurement to become meaningful, actionable and ultimately performative.
The PRECEDE–PROCEED model is a comprehensive and effective framework for designing, implementing and evaluating health promotion and public health programs aimed at improving individual and community health and quality of life. However, the published literature on its application is extensive and dispersed. This protocol outlines a scoping review that aims to map the extent, range and nature of empirical studies employing the PRECEDE–PROCEED model in public health over 25 years. This scoping review will include qualitative, quantitative and mixed-methods empirical studies. A systematic search will be conducted across major electronic databases, including PubMed, Scopus, Web of Science, Embase and ProQuest. Eligibility criteria will be defined using the Population–Concept–Context (PCC) framework, rather than PICO, to suit the descriptive nature of a scoping review. Studies will be screened for eligibility by two independent reviewers based on titles, abstracts and full texts. Data extraction will focus on key characteristics of the studies, including population, concept (application of PRECEDE–PROCEED phases), context (setting and health topic), study design and reported outcomes. Quality appraisal of individual studies will not be performed, aligning with standard scoping review practices, although the breadth of evidence will be described. Reporting will adhere to the PRISMA extension for Scoping Reviews (PRISMA-ScR) and relevant Joanna Briggs Institute (JBI) guidelines. The findings will be presented through a descriptive synthesis of the included studies. This will involve charting extracted data to map the characteristics of the literature, including the types of health promotion programs, target populations, settings, geographical distribution and the specific phases and components of the PRECEDE–PROCEED model that have been applied. This scoping review will provide a comprehensive overview of the existing research landscape concerning the PRECEDE–PROCEED model in public health. It will illuminate patterns of use, identify areas of extensive and limited application and highlight potential gaps in the literature, thereby informing future research directions and practical applications of the model.
Parliaments play an important role in health governance through legislation, budgeting and oversight. However, their practical influence on health policy decisions remains poorly understood in systems where executive institutions and expert actors dominate policy processes. In Iran, health governance is characterized by centralized authority, fragmented institutional arrangements and strong professional hierarchies. This study explored the challenges of parliamentary engagement in health policymaking using Gaventa’s power cube framework. A qualitative descriptive study was conducted using semi-structured interviews with 32 participants, including senior health officials, health policy advisors with experience in parliamentary engagement, representatives from insurance and regulatory bodies, professional association members and health policy academics and researchers who had direct or indirect involvement in health legislative processes. Participants were selected through purposive maximum variation sampling. Data were analysed using reflexive thematic analysis, with initial inductive coding followed by abductive theoretical interpretation through the dimensions of Gaventa’s power cube framework, examining how spaces, levels and forms of power interact to shape parliamentary engagement. Three interrelated themes emerged. First, parliamentary engagement occurred largely within invited policy spaces, while key agenda-setting processes remained concentrated in closed executive and expert arenas. These closed spaces were reinforced by hidden power mechanisms, including selective information dissemination and strategic control over policy framing. Second, fragmented authority across multiple governance levels diluted accountability and constrained effective legislative oversight. Transnational dynamics, including international sanctions, global health organizations and external resource constraints, introduced an additional layer of complexity that further limited parliamentary influence. Third, visible legislative powers were shaped by hidden and invisible forms of power, including control over information, agenda-setting processes, professional authority and dominant expert discourses. Crucially, these three forms of power did not operate in isolation but interacted to create a self-reinforcing cycle: invisible power (professional legitimacy) legitimized closed spaces, while hidden power (agenda control) operated within fragmented governance structures to dilute accountability. Together, these dynamics limited Parliament’s capacity to influence policy formulation and positioned legislative engagement as predominantly reactive rather than proactive. Parliamentary influence in Iran’s health policy system is shaped not only by formal legislative authority, but also by the interaction of policy spaces, governance levels and multiple forms of power. Applying Gaventa’s power cube framework reveals how executive dominance, institutional fragmentation, transnational influences and epistemic authority collectively constrain legislative participation in health policymaking. By demonstrating how closed spaces, fragmented levels and interacting forms of power mutually reinforce one another, this study contributes to a more nuanced understanding of parliamentary engagement in complex health governance systems and offers insights for strengthening legislative involvement in evidence-informed policy processes.
