Analyzing the outcomes of health promotion practices.

This article focuses on health promotion (HP) outcomes, illustrated through evaluation of case studies and identification of strategies which have contributed to their success and sustainability. Evaluation research and practice in three distinct sceneries are discussed: (i) institutional and governmental agencies; (ii) communities in the "Manguinhos Complex" and Nova Iguaqu Municipality, and (iii) building of potentially healthy municipality networks. The effectiveness of a social program in a health promotion perspective was based in the "School for Parents" program, undertaken by the First Court of Childhood and Youth of Rio de Janeiro, between 2001 and 2004. The analysis was grounded in the monitoring of 48 parents in charge of children under 18, who were victims of abuse, violence or negligence, and social exclusion, most of all. The study's objectives were: illustrating the evidence of effectiveness of health promotion, discussing the concept of HP effectiveness under macro unfavorable conditions, and identifying strategies that foster sustainability of results. Institutional resources included a multi-professional staff, multidisciplinary approaches, participatory workshops, family case management, partnership with public and private institutions, and volunteer and civil society sponsorship of the families. Evaluation was based on social impact indicators, and psychosocial and contextual determinants. Evaluation methods included program monitoring and quantitative-qualitative methods, through a longitudinal evaluation of 3 years, including one year post program. The evaluation showed highly favorable results concerning "family integration', "quality of family relations" and "human rights mobilization". Unsatisfactory results such as "lack of access to formal employment" are likely related to structural factors and the need for new public policies in areas such as education, professional training, housing, and access to formal employment. The training process of social actors in environmental management and housing, supported by the Public Health Technology Development Project of the Oswaldo Cruz Foundation, was employed as a tool of environmental education and healthy housing. The purpose of this study was to construct an integrated and participatory model of environment management. The methodology included training, research and evaluation of participants, from 21 to 50 years of age, who participated in building Thematic Learning Books and Community Guides about water quality monitoring. Participants'evaluations emphasized the training process, encouraging them to become multiplier agents of environmental education in their communities and to continue learning how to bring together sectors for problems solving. The Potentially Healthy Districts' Network (RMPS) aimed at increasing knowledge and building capacity to develop actions which originate from each of the local units, based on their characteristics and practices. Developed by the Preventive and Social Department of Campinas State University with PAHO/WHO and the Society Special Research Institute (IPES), RMPS's mission was to cooperate in the construction of healthy public policies in a participatory and articulated way through different municipal representatives. The network offered tools to municipal administrations to develop integrated projects that brought together government, managers, technicians, academy and organizations for the construction of public policies aimed at health promotion and quality of life. The methodology is based in the construction of knowledge and action networks by social actors, stimulating trans-sectorial and inter-district actions. The outcome evaluation is based on case studies, focus groups, oral stories, documents and image analyses.

Theory and practice in the context of health promotion program evaluation.

Evaluation of health promotion (HP) actions is a major challenge, generating inquiries and reflections that can contribute on the effectiveness of the actions themselves. With the aim on fostering exchange on monitoring and evaluation experiences related to the implementation of healthy settings, the 1 st Brazilian Seminar on Health Promotion Effectiveness was launched in 2005. The program included round table and workshops known as Working Groups (WG) in Brazil. The criteria used to constitute the workshops focused settings as spaces of circulation and living as an intrinsic connection to lifestyles and conditions, as well as to social and/or environmental risk factors associated with groups living in these settings day after day. Focusing on evaluation as an activity that generates knowledge, this article highlights and stimulates the discussion about some major issues arising from the theoretical-methodological approach and the discussions developed in the workshops. The debates carried out during the Seminar illustrated the different perceptions and views of the social players involved in implementation and evaluation of H P practices, disclosing a multiplicity of meanings. It became clear that procedures are needed to document a future maturation of concepts and methods, in combination with further in-depth theoretical discussion.