BMC Public Health 2004, 4 http://www.biomedcentral.com/1471-2458/4/11 Monitoring and evaluation Monitoring and evaluation of the programme may be done in a participatory way, based on which the pro- gramme may be redesigned periodically. For monitoring, process level indicators may track the progress of the activ- ities accomplished under each strategy against the targets that are set at the beginning of the intervention. Evalua- tion can be done at regular interval to assess the secular trend in knowledge and practice related to SC. One of the methods of evaluation may be to compare baseline data for a variety of indicators with the post intervention fig- ures to assess the trend. Evidence base for HP and SC interventions Before considering implementation of any public health programme, several issues such as appropriateness, feasi- bility, effectiveness, cost effectiveness and potential need to be carefully considered. Generating an evidence base for evaluating HP programmes, consisting of interven- tions directed at different levels like developing personal skill at individual level, social mobilization at the com- munity level and advocacy to influence public policy, is complex and multidimensional. Experimental studies like randomised control trials, considered as the gold standard in evidence based medicine, have only a limited role in generating evidence for HP programmes. The evidence base on such programmes needs to be generated from several different sources including experimental studies and observational studies using qualitative and quantita- tive methods [65]. There is evidence from a large number of studies that SC and HP interventions work. Moving a step further from these studies, which are conducted in the 'controlled' sit- uations, there are also examples of successful large-scale HP programmes in the 'real world'. In a trial, 391 college students were randomly assigned to intervention or con- trol groups. The intervention, which consisted of provid- ing SC information, resulted in positive changes in the attitude and belief in the intervention group [66]. A med- ical SC programme consisting of 11 sessions of educa- tional intervention produced substantial improvement in health-related knowledge, health skill performance and health action in the intervention group compared to the control group. However there was no evidence that the intervention had any effect on health status or medical care utilization [67]. SC education has been found to be effective in improving the patient condition for a variety of chronic diseases. These diseases include osteoarthritis of knee [68], chronic pain [69,70], headache [71] and back pain [72,73]. Sys- tematic review of large number of studies has showed the clinical and cost effectiveness of self-help treatments for anxiety and depressive disorders [74] and different com- mon disorders [75] and chronic disorders [76,77]. Meta- analysis of studies has showed that SC interventions are effective in improving the outcome and reducing the use of health services in adults with asthma [78]. Conveying appropriate SC information to the patient reduces the use of the health services by 7–17% [79]. The effectiveness of self help groups has been studied and there is indication that self help groups are associated with higher improve- ments compared to the controls [80]. A review of several international surveys on SC practices has concluded that SC practices are often beneficial and SC appears to be a universal behaviour [81]. At the work place, providing SC information to employees is an effective way of reducing employer's health cost. In a company, a programme was implemented using a guide, which contained information on SC of illness and when to refer to professionals. Claim data analysis at baseline and 1 year after the programme indicated a saving of $39.65 per employee (24% reduction in cost) [82]. In large community wide projects, SC information was found to be effective in empowering people to manage their illness resulting in reduction of the use of profes- sional services. Healthwise, a non-profit organization based in US, implemented in a large community wide SC information project, Healthwise Communities Project, in Southwest Idaho, US during 1996–1999. In the project, a SC handbook (Healthwise Handbook) was distributed to each household in the area and a telephone advice line was provided and a web site on SC was set up. The hand- book contained SC information on over 180 common medical problems and when to consult a professional. Workshops were organised in the schools, businesses and churches to inform consumers on SC. Workshops were also organised for doctors, nurses and other providers to inform them on working better with informed consum- ers. The study to assess the effectiveness of the project indicated that the intervention increased the use of SC resources resulting in some reduction of the use of health services [83]. Following the success of this project, similar projects were initiated in the US and in Canada. In the Partners Health Initiative project, implemented in parts of South Carolina and Georgia of US, 154000 families received the Health- wise Handbook. Evaluation of the project indicated that use of the handbook resulted in reduced hospital visits with an estimated cost saving of $34.5 million during 30 months of the initiative. For every dollar invested, there was a saving of 11 dollars of health care costs [84]. Encouraged by the success of these projects, each family in the British Columbia province of Canada has been given a Healthwise Handbook. Page 9 of 12 (page number not for citation purposes)