Evidence for success in health promotion: suggestions for improvement

Abstract

This paper argues that health promotion needs to develop an approach to evaluation and effectiveness that values qualitative methodologies. It posits the idea that qualitative research could learn from the experience of quantitative researchers and promote more useful ways of measuring effectiveness by the use of intermediate and indirect indicators. It refers to a European-wide project designed to gather information on the effectiveness of health promotion interventions. This project discovered that there was a need for an instrument that allowed qualitative intervention methodologies to be assessed in the same way as quantitative methods.

PIP: This article reviews the literature on program evaluation of health promotion strategies. The authors argue that health promotion evaluations must place a greater value on qualitative methods and an assessment of the quality of the research design. Findings from a European review of the effectiveness of health promotion interventions indicate that an instrument needs to be developed for assessing the quality of the research design. Health promotion research tends to focus on the outcomes and the effectiveness of interventions. It is argued that health promotion outcomes must include changes in equity, healthy public policy, community involvement, health services access, and social well-being. The emphasis on outcome measures has influenced the development of strategies that are associated with target setting. The emphasis on outcome and effectiveness measures in the United Kingdom is due to cost containment, quality assurance, and private-public competition for services. Traditional assessments of outcomes and effectiveness are inadequate and unrealistic, due to the reliance on traditional "hard, scientific evidence." Evaluation research of health promotion must seek to gain an understanding of "process," which is best measured by qualitative research methods. It is posited that the academic researcher who is trained in the "logical-positivist" research framework will have different research needs from the planner or program manager. Practical program circumstances are not well understood in terms of cause and effect. Individual decisions about health or illness have multiple or intermediate determinants. A probable behavioral change process includes 30% of audience awareness of the message, 85% understanding of the message, 31% believing the message, 40% having a supportive environment for change, and 3% changing behavior. Good quality theories derived from research need to be developed in order to select indicators of what happens in the "black box."