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Evaluation in Health Promotion: Principles and Perspectives.
  1. M Wise
  1. Executive Director, Australian Centre for Health Promotion, University of Sydney; marilynw{at}health.usyd.edu.au

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    Edited by I Rootman, M Goodstadt, B Hyndman, D McQueen, L Potvin, J Springett, E Ziglio. (Pp 533.) WHO Regional Publications, European Series, No 92. Denmark: World Health Organization, 2001. ISBN 92-890-1359-1.

    Evaluation continues to present health promotion researchers, practitioners, and policy makers with many challenges—conceptual, theoretical, and practical. All organizations and individuals involved in health promotion are familiar with the pressure from inside and outside the field to demonstrate that health promotion “works”. Proving that health promotion is a “worthwhile” investment for governments, non-government organizations, the community sector, and the private sector is a major external pressure on the field. Ensuring that practice is “evidence based”, of high quality, and effective is a powerful internal pressure.

    In many ways, it is little wonder that evaluation continues to challenge us. As this book highlights, there are multiple definitions and no general theory of health promotion. The work addresses the complex array of factors that influence the health and wellbeing of individuals, communities and populations, and practitioners and researchers in the field draw from a variety of disciplines to plan, implement, and evaluate our work. These complexities have been compounded by a growing understanding that different societies and cultures approach health promotion in general, and evaluation in particular, in different ways. In recognition of this, the book is limited to evaluation work in western, industrialised societies (p 5).

    The book is the outcome of the deliberations of a WHO Working Group on Health Promotion Evaluation established by the European Regional Office. It is the fourth product of the collaboration and is comprised of papers commissioned by the working group or submitted for its consideration. The members of the working group represent diverse perspectives, and came from Canada, Europe, and the United States; from governments, WHO, and the academic community; and from different evaluation backgrounds (p 3).

    The goal of the publication was “to stimulate and support innovative approaches to the evaluation and practice of health promotion, by reviewing the theory and best practice of evaluation and by producing guidelines and recommendations for health promotion policy-makers and practitioners, concerning evaluation of health promotion approaches”(p 3). The book includes five parts: introduction and framework, perspectives, settings, policies and systems, and a final synthesis and conclusion. The middle parts include multiple chapters, addressing conceptual, theoretical, and methodological issues. Most illustrate these using case studies. The book does not purport to be a methodology textbook—methodology is, rather, considered to be only one of the issues of importance in health promotion evaluation. The chapters focus on issues pertinent to evaluating health promotion in settings, and the aim is to influence policies and systems. A broad view is taken of what constitutes evidence, suggesting that this is entirely appropriate to health promotion (p 5–6).

    The quality of the chapters is uniformly high—well written, conceptually challenging but accessible, and comprehensively referenced. It is refreshing and stimulating to find a work on evaluation that is not fixated on research methodology and design. The editors/contributors clearly understand the need for rigorous research design in health promotion evaluation and for the use of evidence to guide practice, research, and policy in health promotion as in other health sciences. However, overall, the book reflects the view that methodological issues should follow, not lead, the design and implementation of health promotion and its evaluation. And there are, after all, many existing texts on research methods for health promotion evaluation.

    The book is intended, principally, for experienced practitioners, researchers, and policy makers—for professionals who have grappled with many of these issues in the course of our work. It is not a “how to” guide—rather, it explores the current state of the science and art in relation to contemporary health promotion and its evaluation.

    The chapters are relatively brief, providing an informed summary of the literature and evidence rather than an in-depth exploration of the topic. Nonetheless, the analysis and discussion are not superficial. Each of the chapters addresses a major debate in contemporary health promotion, illuminates the major points at issue, and suggests some ways forward. For this reviewer, the chapters on “what counts as evidence”, on “evaluation of quality of life”, on “policy networks for health”, on “evaluation of countrywide health promotion policies”, and on “investment for health” were of particular interest.

    The book concludes with recommendations for health promotion policy makers about ways to foster more appropriate evaluations of health promotion, and with a generic logic model for planning and evaluating health promotion. In light of the considerable strengths of the book, the recommendations were somewhat disappointing. This is, perhaps, because they could be written only for an international audience. But there was little new in the recommendations although, taken as a set of principles for good practice they do provide a useful guide.

    The generic logic model for planning and evaluating health promotion, however, is a useful, if complex contribution to the field in general and evaluation in particular. The quest for a comprehensive logic model that describes and explains the complex array of factors that influence the health of individuals and populations is likely to continue for some time to come. This refinement, though, will assist practitioners, researchers and policy makers to review our practice and to at least design more appropriate, effective evaluations.

    The contributors have outlined conceptual, theoretical, and practical issues that must be addressed if we are to improve the quality and range of evaluation of health promotion initiatives to change settings, policies and systems. There are, of course, many remaining questions with regard to the practice of health promotion evaluation. Reading the book highlights the large gap between the technical capacity that is available to guide and undertake effective evaluation and the relatively limited application of this in practice. The book did not seek to address this gap, although the recommendations to policy makers essentially seek to bridge it. But much more will be needed if the ideas and challenges presented in the book are to be translated into action. The systematic, routine adoption of the recommendations is, itself, a variation on a health promotion intervention, and the evaluation of methods to ensure this a further challenge.

    In all, the book is highly recommended as a conceptual guide to contemporary health promotion evaluation.

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