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Evaluation
Public health evaluation · Cancer awareness · Community outreach · Prevention
Understanding how community-based cancer prevention was contributing to change in Kent
Social Enterprise Kent needed to understand how Cancer Smart was building awareness and confidence within underserved communities, what still prevented people from acting, and how its impact could be strengthened.
The challenge
Cancer Smart was a community-based cancer-awareness and early-diagnosis programme designed to reach more than 3,000 people from underserved communities across Kent through approximately 150 engagement events.
Working through community organisations, faith groups, grassroots networks and trusted local leaders, the programme aimed to increase awareness of symptoms and screening, build confidence and encourage earlier help-seeking.
Social Enterprise Kent needed to understand more than how many people the programme had reached. It wanted to know what had changed, how the programme had contributed to that change and what was still preventing people from acting.
Prevention is particularly difficult to evaluate. Outcomes such as earlier diagnosis, improved survival and potential system savings emerge over time and are influenced by many factors. It would not have been credible to draw a direct line between attending an event and receiving an earlier diagnosis.
The evaluation therefore needed to trace the steps between community engagement and longer-term impact - while distinguishing meaningful early change from outcomes that could not yet be verified or attributed to the programme.
What we did
The Future Works - working with Linda Jackson of The Loom - designed and delivered a theory-based evaluation combining qualitative research, community engagement and facilitated learning.
Developing a credible account of preventative change:
We mapped the pathway through which Cancer Smart was expected to contribute to earlier diagnosis.
This enabled us to distinguish between:
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programme activity and reach;
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immediate changes in awareness and understanding;
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confidence and intention to act;
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actual help-seeking or screening behaviour;
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service uptake and earlier diagnosis;
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and longer-term health and financial outcomes.
This distinction was critical. It allowed us to identify meaningful early evidence of change while remaining honest about outcomes that could not yet be verified or attributed directly to the programme.
Gathering lived experience in trusted settings:
Rather than expecting people from underserved communities to enter a separate, formal research process, we gathered insight through existing Cancer Smart events and programme activities.
This enabled us to hear from people in familiar settings, including community groups, education settings and spaces supported by trusted local organisations and leaders.
We observed how people engaged with cancer information, the questions they felt able to ask, what they intended to do differently and what they believed would make screening and healthcare more accessible.
This reduced barriers to participation and kept lived experience central to understanding the programme’s impact.
Exploring direct and wider 'ripple effects':
We used qualitative research and Ripple Effects Mapping to explore changes beyond the individual participant.
This included considering how:
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participants shared cancer information with family, friends and their wider communities;
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community champions became more confident discussing symptoms and screening;
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trusted organisations strengthened their role as a bridge between communities and health services;
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relationships developed between grassroots groups and health partners;
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and community insight revealed where services themselves needed to change.
We also brought together participant feedback, programme evidence, stakeholder perspectives and relevant health-system data to test the emerging account of change.
Supporting learning and future development:
The evaluation was designed to support decision-making. Facilitated conversations helped delivery partners and stakeholders interpret emerging findings, examine assumptions and consider the implications for future delivery.
We translated the evidence into practical recommendations concerning community engagement, accessibility, culturally responsive communication, partnership working, sustainability and future impact measurement.
What changed
The evaluation gave Social Enterprise Kent and the Cancer Alliance a clearer, evidence-based account of what Cancer Smart’s community-based approach was achieving - and where awareness activity met barriers requiring wider system action.
The evidence pointed to meaningful early change. Across community sessions, participants reported greater awareness of cancer symptoms, screening and risk. Some intended to begin self-checking, attend relevant tests or speak to a healthcare professional, while others took information away to share with family members and their wider communities.
The evaluation captured how the setting and method of engagement influenced these outcomes. In a trusted group for older South Asian community members, people asked questions they might not have raised elsewhere and reported feeling more confident about approaching their GP. At an informal pop-up in an education setting, creative activities attracted people who might not have attended a conventional cancer-awareness session and prompted intentions to check their bodies or take future action.
It also highlighted the important role of Cancer Smart Champions and trusted community organisations. Information was not simply reaching individual participants; it was travelling through existing relationships and community networks.
However, the evaluation showed that knowledge and motivation were only part of the picture. Continuing barriers included:
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limited access to convenient, local screening and suitable appointment times;
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language, health-literacy and accessibility barriers;
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uncertainty about screening processes and how to navigate services;
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cultural concerns, previous experiences of healthcare and the need for culturally competent or same-gender care;
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and the importance of empathetic, mental-health-aware and person-centred services.
This sharpened a central conclusion: Cancer Smart could build awareness, confidence and intention, but whether that intention became action also depended on the accessibility and responsiveness of the wider health system.
The evaluation therefore provided a more credible account of the programme’s contribution to preventative change, evidence about the value of trusted community relationships and a clearer picture of the structural barriers limiting screening and help-seeking.
We presented the findings to system stakeholders, creating space to explore their implications for future delivery, partnership working and system action. The final report was subsequently used by the Kent and Medway Cancer Alliance Board to inform its onward conversations and decision-making.
The evaluation also established important evidence boundaries. Increased awareness and intended behaviour change were meaningful early outcomes, but should not be presented as verified increases in screening uptake, earlier diagnosis or cost savings without appropriate longer-term data.
Our 'special sauce' on this project
Evaluating prevention requires a different mindset from evaluating a service. The most important impact may be something that happens months or years later: a person recognising a symptom, attending screening, approaching a GP sooner or encouraging somebody else to seek help.
Our value came from combining four areas of expertise.
1. Understanding how preventative change happens. We could identify the credible steps between community engagement and longer-term health outcomes. This enabled us to recognise meaningful early change without confusing increased awareness or intention with verified behaviour, diagnosis or system savings.
2. Systems-change and health-inequalities expertise. We understood that late diagnosis is not simply the result of individuals lacking information. Structural inequality, service design, language, culture, trust, power and previous experiences of healthcare all influence whether people can act. This prevented the evaluation from placing responsibility for change entirely on underserved communities.
3. Community engagement and lived-experience practice. We gathered insight in places where people already felt comfortable, working through trusted community relationships rather than relying solely on formal research channels. This helped us hear from people who might otherwise be absent from an evaluation and understand not only what they knew, but how services and cancer messages felt from their perspective.
4. Research, evaluation and facilitation expertise. We combined theory-based evaluation, qualitative inquiry and Ripple Effects Mapping with facilitated stakeholder learning. This allowed us to move between individual experiences, community-level effects and wider system implications, and translate complex evidence into practical recommendations.
Social Enterprise Kent was deeply connected to the programme and its community partners. Our independent role enabled us to test assumptions, distinguish delivery success from strength of evidence and surface difficult findings about the barriers communities continued to experience.
Another evaluator might have counted how many people Cancer Smart reached or measured changes in knowledge immediately after an event.
Our contribution was to explain what change had been made, how it had happened, what impact could credibly be evidenced, what was preventing that impact from going further and what both the programme and the wider health system needed to do next.
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