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Evaluating Health Promotion

BMJ 1999; 318 doi: (Published 06 February 1999) Cite this as: BMJ 1999;318:404
  1. Don Nutbeam, professor of public health
  1. Department of Public Health and Community Medicine, University of Sydney, Australia

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    Ed David Scott, Ross Weston

    Stanley Thornes, £18, pp 176

    ISBN 07487 33132


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    This is a collection of essays that provide a range of perspectives on evaluation. Readers hoping for practical advice on how to conduct an evaluation will be disappointed. The target audience for the book is not clearly defined, but it is certainly not those with a peripheral or early interest in evaluating health promotion programmes. The book instead takes the reader on a tour of different models, evaluation designs, and measures of success for the purpose of enriching debate.

    The opening chapters are hard work, especially for readers unfamiliar with the jargon of postmodernism and educational research. There are, however, rewards for those with the commitment to wade through these difficult passages. They provide a snapshot of the different perspectives to the research task (such as medical, educational, political radical, etc) and consider the relative merits of qualitative and quantitative research and the notion of an evaluator as a neutral observer of phenomena. The closing chapters are equally demanding of the reader in examining ethical issues in research and considering the conversion of theory into practice.

    Sandwiched between these essays from the editors are the “meaty” contributions from several experienced and respected health promotion researchers and practitioners. Chapters by Keith Tones and Viv Speller set out, in a more readable form, many of the fundamental methodological and practical issues that make evaluating health promotion programmes a complex and dangerous task for researchers. Both authors make the point that there is often a trade off between what is desirable from the researcher's perspective (maximum definition and control over all intervention) and what is desirable from the perspective of a health worker and the community (loose definition of programme content and sequence, but good procedures for quality control). Both identify the folly of evaluating programmes that are so narrowly defined or so highly refined as to be ineffective or impossible to reproduce. Bad interventions generate bad results, however good the evaluation design.

    The chapters by the more established authors are almost entirely derived from previously published work. In this sense the book does not add a great deal to what has already been written on evaluating health promotion. However, its diversity is a strength, offering in one volume what would otherwise take time to gather through a literature search.

    Overall, the strongest message that emerges is that the search for a “definitive study” in health promotion is illusory. Tones argues that methodological pluralism is not only acceptable but essential. Advances in knowledge in health promotion will continue to be developed in an incremental process, with the best available evidence derived from a range of different study designs and methodologies.

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