An Evaluation Framework for Health Promotion: Theory, Quality and Effectiveness

Abstract

There is increasing demand for evaluation work funded by public agencies to become more focused on demonstrating effectiveness. Focusing evaluation on outcomes and effectiveness meets the information needs of strategic planners and policy makers, but other stakeholders involved in managing, delivering or using public services and programmes may use other assessment criteria, such as improving the quality of programmes or programme design. The necessity and value of these other criteria are in danger of being obscured. Acknowledging the legitimacy of the range of stakeholder perspectives, this article presents a framework for evaluation that has been developed over a number of years within the context of evaluating health promotion programmes as part of the work of a national health promotion agency. It argues for an approach to evaluation which recognizes the contributions of theory and quality as well as effectiveness in programme development. The Health Education Board for Scotland (HEBS) framework for evaluation – and the analysis that informed it – demonstrates that there are many stages and forms of evaluation which contribute to the development of effective interventions. While outcome evaluations and effectiveness reviews tend to be the prized evaluation products for those concerned with policy and strategic planning, these forms of evaluation are just ‘the tip of the iceberg’ of what is required to build a sound evidence base, bringing together the full range of evaluation needs from the perspectives of all the different stakeholder groups.

The Practice and the Theory

“…Their rise in popularity stems from the proliferation of the commissioning of complex interventions and the hope that such approaches can overcome the limitations of previous social programme evaluations (Wimbush and Watson, 2000). Rather than simply judging complex community interventions in their entirety as successes or failures (Susser, 1995) there is a recognized need to uncover what aspects of an intervention have or have not been successful with which particular subgroups (Pawson and Tilley, 1997).…”

Conceptualising the effectiveness of impact assessment processes

“…In terms of its definition, for Young and Levy (1999, p.3), 'effectiveness' is "a matter of contribution that institutions make to solving the problems that motivate actors to invest the time and energy needed to create them". Wimbush and Watson (2000) consider that intended and unintended effects of policies, projects and programmes could be identified as a result of effectiveness evaluation. This suggests that 'effectiveness' can be observed based on the outcome of actions.…”

The gradient in health inequalities among families and children: A review of evaluation frameworks

“…The importance of building in evaluation of the policy or intervention process within an effective evaluation framework was stressed [43]. Many of the evaluation frameworks reviewed made explicit the importance of community participation by those whose health needs are being addressed [52,53,42], but surprisingly some frameworks do not do this, or do not elaborate in enough detail [46,60]. Some of the frameworks did consider the ethical aspects of the policy or intervention being evaluated [52,46], although none specifically took steps to minimise harm to the participants involved in the evaluation.…”