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Evaluating what works is essential in efforts to prevent injuries
Two papers, one from Sweden1 and one from Australia,2 in this issue describe evaluations of injury prevention interventions. In both, multimodal community based interventions were implemented in defined geographic areas. Both face the challenges of evaluating a complex intervention, delivered in a “real world” setting and without a randomized trial structure.
Evaluating injury prevention efforts is vital to reduce the rising toll of mortality, morbidity, and economic losses arising from injuries, not only to identify effective prevention measures but also to shift resources from what does not work to what does. For these reasons, it is essential that evaluation be of the highest methodological standard possible.
BELIEF IN INJURY PREVENTION IS WHY WE DO EVALUATION BUT NOT HOW
In most scientific inquiry, the investigator approaches a problem with a hunch or more formally, a hypothesis. In the injury prevention field, most of us are believers, of varying degrees of fervency, that injuries can be prevented and that interventions to do so can be implemented. These beliefs motivate evaluation but the evaluation itself can rarely if ever provide the positivist proof that the intervention reduced rates or severity of injuries.
Ensuring that the evaluation's conclusions are able to withstand alternative explanations is critical. For this …
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