Those of us working in health promotion research are all too familiar with the debate about what constitutes evidence of effectiveness and the inadequacy of current evaluation designs when applied to real-life, complex community interventions.
Evaluating Health Promotion is a useful contribution to this debate and the editors have achieved their objective of challenging the dominance of any one approach to evaluation by including an eclectic mix of contributions.
The book includes an analysis of the historical context of health promotion and theoretical discussions on positivism and ethics. There are chapters on planning models, quality assurance, discourse analysis and qualitative evaluation. The chapter on best practice in cancer control programme evaluations provides some good case study examples - other sections of the book would also have benefited from more grounded examples.
This book is not a guide to evaluation techniques - that is not its purpose. It aims to stimulate debate about how evaluators might work together to improve the knowledge base of health promotion.
The various methods used to amass evidence are discussed, but there is clearly a bias towards discussion of the more qualitative approaches to evaluation. This is justified in so far as many practitioners value the insights provided by qualitative investigations of complex communities, which quantitative research tends not to provide.
Indeed many practitioners would agree with several of the contributors, who rightly state that the lack of attention given to illuminative or process studies to explain why a given programme has failed or succeeded has resulted in key features of the intervention design not being understood.
However, the call for methodological pluralism in health promotion research is echoed throughout the book.
With the increasing legitimisation of programmes targeted away from the individual to address the wider determinants of health, the challenge remains to develop robust methodologies for assessing the value of multi- faceted interventions targeted at communities.
The marshalling of data generated by a range of research methods is essential to building up the evidence base. As Wiggers and Sanson-Fisher state, without such evidence scarce resources are likely to be inappropriately allocated, resulting in inequities both for those who receive health promotion interventions and those who do not.
But while the medical hegemony remains with its biomedical model of healthcare delivery, the lack of agreed standards of what constitutes evidence of effectiveness in health promotion will mean resources for these interventions will remain scarce, despite the widespread belief that the methods the biomedical model prescribes will never address the health inequalities that exist today.
This book is a useful addition to the debate.
Dominic McVey head of research, Health Education Authority