RESUMO
The main purpose of this article is to question the relevance of the Randomised Controlled Trial for the evaluation of health promotion programmes. In its concern to manage Type 1 error, the RCT underestimates or virtually ignores Type 2 and 3 errors. Because of the peculiar complexities of health promotion programmes and the importance of gaining insights into the effect of interventions--rather than merely recording whether or not they achieve their goals--a new kind of validity is needed. The central assertion here is that we should adopt a principle of "judicial review" which is based on a broad spectrum of triangulated evidence.
Assuntos
Promoção da Saúde/normas , Avaliação de Programas e Projetos de Saúde/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/normas , Viés , Interpretação Estatística de Dados , Humanos , Indicadores de Qualidade em Assistência à Saúde , Reprodutibilidade dos TestesAssuntos
Educação em Saúde , Promoção da Saúde , Relações Interinstitucionais , Sociedades , HumanosRESUMO
The importance of a sound evidence base for health promotion is recognized. Criteria for establishing evidence have, in the past, been heavily influenced by the bio-medical agenda. The problems in using experimental and quasi-experimental approaches and their limited relevance for evaluating health promotion interventions are examined. The multifactorial nature of the health promotion enterprise in relation to both inputs and outputs is recognized and a range of direct, indirect and process indicators are identified. The relevance of combining quantitative and qualitative methods for data collection is discussed and the paper concludes by advocating a 'judicial principle' for assessing evidence.
Assuntos
Medicina Baseada em Evidências , Promoção da Saúde/métodos , Coleta de Dados , Estudos de Avaliação como Assunto , Comportamentos Relacionados com a Saúde , Humanos , Projetos de Pesquisa , Reino UnidoRESUMO
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."
