Alternative approaches to assessing the effectiveness of health promotion interventions




Carroll, Simon

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Health promotion interventions are a key public health strategy aimed at improving population health and reducing health inequities. It is paramount that societies be able to assess whether investments in health promotion strategies are effective. However, the traditional or orthodox, evidence-based medicine approach to assessing the effectiveness of medical interventions has not proved to be appropriate for assessing health promotion interventions. Thus, there is a desperate need for workable, alternative approaches to assessing health promotion effectiveness. This study reviews current work in the field aimed at developing such alternatives and provides a critical analysis of some of the deep methodological challenges that confront this work. Through the use of a specific case study of a project aimed at implementing one of these alternative approaches ('realist synthesis'), this dissertation offers an original, empirically based analysis of the types of emerging issues that one particular attempt at developing an alternative approach must deal with. This study offers an ethnomethodological analysis of video-recorded 'work sessions', where the research team is working through specific aspects of the 'realist synthesis' project; particularly the conceptualization and categorization of 'contextual factors', and the identification and specification of `outcomes'. Through this analysis, it is demonstrated that alternative approaches to synthesizing evidence for health promotion interventions must rely upon the mundane, practical, everyday competencies of 'abstraction' and 'objectification' as they are carried out, for all practical purposes, by a research team, as it goes about solving problems and completing normal research tasks. The study concludes that much more attention needs to be paid to developing skills, representational tools and training research assistants, if alternative approaches are to be successful in completing reviews and sustaining credibility for end-users.



Health promotion, Realist synthesis