BMJ 1999;318:404 ( 6 February )
Reviews
Multimedia
Evaluating Health Promotion
Ed David Scott, Ross Weston
Stanley Thornes, £18, pp 176
ISBN 07487 33132
Rating: ***
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.
Don Nutbeam, professor of public health.
Department of Public Health and Community Medicine, University of Sydney,
Australia
© British Medical Journal 1999
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Dennis Raphael, Ph.D.
Associate Professor and Associate Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
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Toronto, Ontario, CANADA M5S 1A8
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