Evaluating complex community-based health promotion: Addressing the challenges

Abstract

Community-based health promotion is poorly theorised and lacks an agreed evidence-base. This paper examines characteristics of community-based health promotion and the challenges they present to evaluation. A review of health promotion evaluation leads to an exploration of more recent approaches, drawing on ideas from complexity theory and developmental evaluation. A reflexive analysis of three program evaluations previously undertaken as an evaluation consultant is used to develop a conceptual model to help in the design and conduct of health promotion evaluation. The model is further explored by applying it retrospectively to one evaluation.Findings suggest that the context-contingent nature of health promotion programs; turbulence in the community context and players; multiple stakeholders, goals and strategies; and uncertainty of outcomes all contribute to the complexity of interventions. Bringing together insights from developmental evaluation and complexity theory can help to address some evaluation challenges. The proposed model emphasises recognising and responding to changing contexts and emerging outcomes, providing rapid feedback and facilitating reflexive practice. This will enable the evaluator to gain a better understanding of the influence of context and other implementation factors in a complex setting. Use of the model should contribute to building cumulative evidence and knowledge in order to identify the principles of health promotion effectiveness that may be transferable to new situations.

Implementation of a journal prototype for pregnant and parenting adolescents

“…Consistent with the implementation science literature, we aimed to capture in-depth information on participant and contextual factors in a complex setting that facilitated or hindered successful implementation. Practitioners and scholars can then draw on these factors to enhance future implementation efforts to tailor programs and interventions to be more congruent with and accommodative the needs of the clients being served (Jolley, 2014;Stetler et al, 2006).…”

“…Drawing on literature suggesting the importance of program evaluation ( e.g., de Meij et al 2013;Fixsen et al 2005), the main strength of this study is that we used multiple methods of data collection and analysis to conduct a robust formative evaluation of this initial phase of the program (Jolley, 2014). The results of this evaluation can assist not only the research team as we pursue future phases of the project, but also practitioners interested in testing similar programs (Stetler et al 2006).…”

A theory-based evaluation of a community-based funding scheme in a disadvantaged suburban city area

“…The benefits of program theory evaluation lie in its ability to highlight the logic underpinning an intervention and, in turn, to help build knowledge of how and why an intervention works, or fails to work (Jolley, 2014). The approach also serves to forefront stakeholder perspectives, and surface both underlying assumptions and implementation mechanisms.…”

Conceptualizing the wider societal outcomes of a community health programme and developing indicators for their measurement

“…With an emphasis on multiple factors at multiple levels, and the purposeful input from all those who experience change (Chaudoir et al, 2013), locating SROI within an ecological model of health can encourage researchers to acquire data irrespective of the ecological level at which it occurs. This reflects the ecological model's emphasis on multiple, overlapping and interacting influences on health (Golden and Earp, 2012;Jolley, 2014). Thinking expansively in this way emphasizes health and the complex environment in which the causes and conditions of individual health behaviour are determined (Best et al, 2003;Commers et al, 2007;Green and Tones, 2010).…”