Evaluating effectiveness in health promotion: a case of re-inventing the millstone?

Abstract

The search for a conceptually sound and practically useful evidence base for health promotion is one of the more pressing needs in health promotion research. This would allow health promotion within the NHS to break free of the constant need to justify specialist health promotion budgets to cash-strap ped commissions. It has been argued that approaches, to health promotion effectiveness should include: consideration of the quality of the intervention undertaken; rigorous criteria for evaluating qualitative methods; organ isational impact as well as individual health-behaviour change; consideration of the effectiveness of different approaches to health promotion across topic boundaries. In this paper, it is argued that simply applying the paradigms of social and behavioural science is not a sufficient response to this challenge. This contention is illustrated with reference to a study undertaken to address these four points, using local evaluation reports. If health promotion is to avoid re-creating the type of millstone which has arisen from accepting a quantitative, outcomes-based view of effectiveness, then greater thought needs to be given to the type of model which should be used. The multi-disciplinary nature of health promotion must be reflected in its approach to evaluating effectiveness. One model is discussed which uses reflective-practice techniques to move beyond efforts at evaluation in the traditional framework of input- process-impact-outcome.